Subject: OAR 461-001-0000 which defines certain terms used in
the eligibility rules for numerous programs is being amended to indicate that
State Plan Personal Care (SPPC) situations, in the context of community based
care, are not considered nonstandard living arrangements. This rule is also
being amended to define certain terms as part of the implementation of Express
Lane Eligibility (ELE).

OAR 461-025-0311
about which clients may be eligible for continuing benefits pending a contested
case hearing in the Department’s public assistance, medical and supplemental
nutrition assistance programs is being amended to state when there is no right
to continuing benefits in the Department’s programs when the pending contested
case hearing is due to a mass change reducing, ending, or otherwise changing
program benefits. This rule also is being amended to make permanent the
temporary changes made to this rule effective August 16, 2010.

OAR 461-101-0010
about the acronyms the Department uses in the chapter 461 rules is being
amended in response to House Bill 2116 (2009 Or. Laws ch. 867) to revise the
acronym for Oregon Health Plan Persons Under 19 (OHP-CHP). This rule is being
further amended to remove outdated program acronyms. This rule also is being
amended to make permanent the temporary changes of August 16, 2010.

OAR 461-110-0630
about how the Department determines the composition of a need group (the
individuals whose basic and special needs are used in determining eligibility
and benefit level) is being amended to state that a need group in the Healthy
KidsConnect (HKC) or Oregon Health Plan (OHP) program also may be formed under
Express Lane Eligibility (ELE) provisions in OAR 461-150-0055. This rule also
is being amended to make permanent the temporary rule changes of August 16,
2010.

OAR 461-115-0071
about who must sign an application and complete the application process for the
Department’s programs administered under chapter 461 of the Oregon
administrative rules is being amended to allow an application to be signed and
the application process completed by a single individual in a household in the
Healthy KidsConnect (HKC), Medical Assistance Assumed (MAA), Medical Assistance
to Families (MAF), Oregon Health Plan (OHP), Refugee Assistance (REF), Refugee
Assistance Medical (REFM), and Temporary Assistance to Needy Families (TANF)
programs. This rule also is being amended to make permanent the temporary rule
amendments made effective July 15, 2010.

OAR 461-120-0210
about when a client is required to provide or apply for a social security
number (SSN) to be eligible for Department programs is being amended to state
when a newborn child may be added to a Temporary Assistance for Needy Families
(TANF) program benefit group without meeting the SSN requirements of this rule.

OAR 461-130-0305,
461-130-0310, 461-130-0315, 461-130-0320, 461-130-0323, 461-130-0325,
461-130-0327, 461-130-0328, 461-130-0330, and 461-130-0335 about the Department
requirements for certain Post-Temporary Assistance for Needy Families
(Post-TANF), Pre-Temporary Assistance for Needy Families (Pre-TANF), Refugee
(REF), Supplemental Nutrition Assistance Program (SNAP), and Temporary
Assistance for Needy Families (TANF) program clients to participate in
Department employment programs are being changed to reflect current Department
terminology, policy, and practices. These rules set the requirements and
responsibilities around the Department administration of the employment
programs, state which clients must participate in the employment programs,
state the clients’ responsibilities when required to participate in the
employment programs, and state the penalties to clients for unexcused
noncompliance with employment program participation requirements. OAR
461-130-0305 about general provisions for client participation in the
employment programs of the Post-Temporary Assistance for Needy Families
(Post-TANF), Pre-Temporary Assistance for Needy Families (Pre-TANF), Refugee
(REF), Supplemental Nutrition Assistance Program (SNAP), and Temporary
Assistance for Needy Families (TANF) programs also is being amended to revise
its description of what these rules cover and definitions for key terms used in
the division 130 of these rules. This rule also is being amended to state when
a SNAP program client is registered for an employment program. OAR 461-130-0310
about how the Department assigns clients to one or more participation
classifications in the Post-Temporary Assistance for Needy Families
(Post-TANF), Pre-Temporary Assistance for Needy Families (Pre-TANF), Refugee
(REF), Supplemental Nutrition Assistance Program (SNAP), and Temporary
Assistance for Needy Families (TANF) programs also is being amended to state
that the Department classifies all Post-TANF program clients who participate in
an employment program as volunteers. This rule also is being amended to change
the term child in the provisions concerning the Pre-TANF, REF, and TANF
programs to the term dependent child. This rule also is being amended to
restate which SNAP program clients the Department considers exempt from
participating and which are mandatory to participate in the SNAP employment
program. OAR 461-130-0315 about the requirements a mandatory client selected by
the Department to participate in a Pre-Temporary Assistance for Needy Families
(Pre-TANF), Refugee (REF), Supplemental Nutrition Assistance Program (SNAP),
and Temporary Assistance for Needy Families (TANF) program employment program
must meet also is being amended to state what a client must do when offered
employment, to maintain employment, and to complete employment-related activities.
This rule also is being amended to state what information the client must
report to the Department and how this information must be reported. OAR
461-130-0320 about the employment program participation requirements for a
mandatory Supplemental Nutrition Assistance Program (SNAP) client is being
repealed and its relevant provisions are being placed into OAR 461-130-0315 to
streamline the Department’s rules by placing all mandatory client participation
requirements into OAR 461-130-0315. OAR 461-130-0323 about the participation
requirements for State Family Pre-SSI/SSDI (SFPSS) program clients is being is
being repealed and its relevant provisions are being placed into OAR
461-135-1195 to streamline the Department’s rules and properly place the rule’s
relevant provisions. OAR 461-130-0325 about the employment program
participation requirements for mandatory Refugee (REF), Supplemental Nutrition
Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF)
program clients and exempt SNAP program clients is being repealed and its
relevant provisions are being placed into OAR 461-130-0315 and 461-130-0330, as
applicable, to streamline the Department’s rules and properly place the rule’s
relevant provisions. OAR 461-130-0327 about the circumstances under which a
client is excused for good cause for failure to comply with the requirements of
an employment program also is being amended to restate the circumstances under
which a client is excused for good cause, including the Department’s failure to
provide a reasonable accommodation when the failure to comply is caused by an
aspect of the client’s disability. This rule also is being amended to state
when the Department may require documentation of a client’s physical or mental
impairment. OAR 461-130-0328 about the effect of a strike on a client’s
requirements to participate in an employment program also is being amended to
state when a Refugee Assistance (REF) program filing group (the individuals
from the household whose circumstances are considered in the eligibility
determination process) is ineligible for program benefits due to a member being
a striker. OAR 461-130-0330 about the circumstances under which the Department
may disqualify a Post-Temporary Assistance for Needy Families (Post-TANF),
Pre-Temporary Assistance for Needy Families (Pre-TANF), Refugee (REF),
Supplemental Nutrition Assistance Program (SNAP), or Temporary Assistance for
Needy Families (TANF) program client from receiving program benefits also is
being amended to state that a volunteer participant in an employment program
may not be disqualified from program benefits. This rule also is being amended
to state when a mandatory Pre-TANF, REF, or TANF client without good cause may
be disqualified from program benefits. This rule also is being amended to state
when a SNAP program client classified as exempt may be disqualified from
program benefits. OAR 461-130-0335 about the circumstances under which the
Department may remove the disqualification of a client in the Refugee (REF),
Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for
Needy Families (TANF) programs is being amended to restate when the Department
removes the disqualification from program benefits for a client disqualified
under OAR 461-130-0330 and the effect the removal has on the restoration of the
client’s benefits.

OAR 461-135-0010
about when a client is assumed eligible for benefits under certain medical
programs is being amended to remove the requirement that a child meet the
citizenship verification requirements under OAR 461-115-0705 to be assumed
eligible for the Medical Coverage for Children in Substitute or Adoptive Care
(SAC) program.

OAR 461-135-0210
about when a Temporary Assistance for Needy Families (TANF) program client or caretaker
relative of a TANF program client may receive a cooperation incentive (a
payment made to a JOBS program client to motivate and recognize progress toward
employment and self-sufficiency) is being amended to state that the cooperation
incentive payments ended effective September 30, 2010. This rule also is being
amended to make permanent the temporary changes made to this rule effective
August 16, 2010.

OAR 461-135-0400
about the specific eligibility requirements for child care payments and the Employment
Related Day Care (ERDC) program is being amended as part of the implementation
of budget cuts at the Department. The amended rule adds to the requirements for
new applicants to this program with a requirement that new applicants must have
received benefits in the Refugee Assistance (REF), State Family Pre-SSI/SSD
(SFPSS), or Temporary Assistance to Needy Families (TANF) programs within at
least one of the prior three months and clarifies who is considered a new
applicant. This rule also is being amended to state that applicants denied
eligibility for ERDC program benefits will be placed on a reservation list.
This rule also is being amended to make permanent the temporary rule changes
made effective October 1, 2010.

OAR 461-135-0780
about eligibility for Pickle Amendment clients in the Oregon Supplemental
Income Program Medical (OSIPM) program is being amended to identify that a term
used in this rule is defined in another rule and cross-reference that rule.

OAR 461-135-1100
about the specific eligibility requirements for an individual to receive Oregon
Health Plan (OHP) program benefits is being amended to remove the eligibility
requirement that an OHP Adults (OHP-OPU) program client select a medical,
dental, and mental health managed health care plan (MHCP) or primary care case
manager (PCCM), unless exempted under other Department rules. In addition, this
rule is being amended to state the circumstances under which the Department may
enroll a child in Oregon Health Plan Persons Under 19 (OHP-CHP), Oregon Health
Plan Children (OHP-OPC), or Healthy KidsConnect (HKC) program based on a
determination made by an Express Lane Agency (ELA). This rule also is being
amended to state when the Department may use Express Lane Eligibility (ELE) for
a child. Moreover, this rule is being amended to provide that in the OHP-CHP
program a child no longer must select a managed care plan for medical or dental
as an eligibility requirement. This rule also is being amended to make
permanent the temporary changes made effective July 15, 2010, August 16, 2010,
and August 25, 2010.

OAR 461-135-1125
about how the Department determines which individuals included on the Oregon
Health Plan - Adults (OHP-OPU) program Standard Reservation List are selected
to apply for the OHP-OPU program is being amended to restate the definition for
“OHP Standard Reservation List Applicant,” and state how the Department
responds to an individual requesting and being granted placement on the OHP
Standard Reservation List. This rules is being amended to state that the
Department must review applications received for eligibility under all medical
assistance programs, and how new OHP-OPU applicants are managed. This rule also
is being amended to make permanent the temporary rule changes made effective
August 16, 2010 and October 1, 2010.

OAR 461-135-1195
about the specific requirements to be eligible for the State Family
Pre-SSI/SSDI (SFPSS) program is being amended to add requirements previously in
OAR 461-130-0323 that state the activities in which an SFPSS program client is
required to or may participate, and to state the information which an SFPSS
client must provide to the Department.

OAR 461-135-1197
about how the Department determines if a client in the State Family
Pre-SSI/SSDI (SFPSS) program has good cause for failure to comply with a
requirement of the SFPSS program is being adopted to state when an SFPSS
program client has good cause for failure to comply with a requirement of the
SFPSS program.

OAR 461-135-1250
about specific client eligibility and participation requirements in the
Post-TANF program is being amended to state that effective October 1, 2010 the
monthly Post-TANF benefit amount will be $50 (reduced from $100). This rule
also is being amended to make permanent the temporary changes made to this rule
effective August 16, 2010.

OAR 461-150-0055
about eligibility and budgeting in the Oregon Health Plan (OHP) program is
being amended to state how the Department determines the budget month (the
calendar month from which information is used to determine a client’s
eligibility and benefit level) when the Department initiates a redetermination
of eligibility. This rule also is being amended to state how the Department
determines the composition of the need group (the individuals whose basic and
special needs are used in determining eligibility and benefit level) and the
income of the financial group (the individuals whose income and resources count
in determining eligibility and benefit levels) when an Express Lane Agency
(ELA) determination finds a child eligible for the Oregon Health Plan Persons
Under 19 (OHP-CHP), Oregon Health Plan Children (OHP-OPC), or Healthy
KidsConnect (HKC) program. This rule also is being amended to make permanent
the temporary changes made effective August 16, 2010.

OAR 461-155-0030
about the income and payment standards in the Refugee Assistance (REF) and
Temporary Assistance for Needy Families (TANF) programs is being amended to
state the payment standard (used to calculate cash benefits for a need group with
an adult) that became effective on October 1, 2010. This rule also is being
amended to make permanent the temporary changes made to this rule effective
August 16, 2010.

OAR 461-155-0035
about how the Department determines the amount of the payment for a cooperation
incentive (a monthly payment added to the cash grant) for a need group (the
individuals whose basic and special needs are used in determining eligibility
and benefit level) in the Refugee Assistance (REF) and Temporary Assistance for
Needy Families (TANF) programs is being amended to state that the cooperation
incentive payments ended effective September 30, 2010. This rule also is being
amended to make permanent the temporary changes made to this rule effective
August 16, 2010.

OAR 461-155-0180
about the poverty related income standards used in some of the Department’s
programs is being amended to state the monthly income standard when set at 163
percent of the 2010 federal poverty level. This rule also is being amended to
restate the poverty related income standards based on the 2010 federal poverty
level. In addition, this rule is being amended to make permanent the temporary
changes made effective August 16, 2010.

OAR 461-155-0225
about the income standards used in some medical programs is being amended to
revise the income standard in the Oregon Health Plan and Healthy KidsConnect
programs for gross income from a business entity assigned to a budget month
(the calendar month from which information is used to determine a client’s
eligibility and benefit level). This rule also is being amended to state the
Department determines the countable income standard for a child found eligible
for medical assistance benefits by an Express Lane Agency (ELA) determination
under OAR 461-150-0055(5). In addition, this rule is being amended to make
permanent the temporary changes made effective August 16, 2010.

OAR 461-155-0320
about the payment standards (used to calculate cash benefits for a need group)
in the State Family Pre-SSI/SSDI (SFPSS) program is being amended to state the
payment standards that became effective on October 1, 2010. This rule also is
being amended to make permanent the temporary changes made to this rule
effective August 16, 2010.

OAR 461-155-0528
about special need emergency assistance payments for clients in the Oregon
Supplemental Income Program Medical (OSIPM) program is being adopted to provide
special need emergency assistance payments to certain OSIPM program clients who
experience unexpected costs, or loss of income or resources. This rule also is
being adopted to make permanent the temporary changes to this rule effective
October 13, 2010.

OAR 461-155-0688
about prescription drug co-pay coverage in the Oregon Supplemental Income
Program Medical (OSIPM) is being amended to restate which OSIPM program clients
receiving Supplemental Security Income (SSI) payments are eligible for the
co-pay coverage. This rule also is being amended to make permanent the
temporary changes made effective October 1, 2010.

OAR 461-155-0693
about transportation services payments in the Oregon Supplemental Income
Program Medical (OSIPM) is being amended to restate which OSIPM program clients
receiving Supplemental Security Income (SSI) payments are eligible for the
payments. This rule also is being amended to make permanent the temporary
changes made effective October 1, 2010.

OAR 461-160-0410
about the treatment of income and income deductions in the Supplemental
Nutrition Assistance Program (SNAP) when a group includes ineligible or
disqualified members is being amended to restate how the Department calculates
SNAP program benefits when a qualified non-citizen is a member of the financial
group (the individuals whose income and resources count in determining
eligibility), does not meet alien status requirements, and is not in the need
group (the individuals whose basic and special needs are used in determining
eligibility and benefit level) and the filing group (the individuals whose
circumstances are considered in the eligibility determination process) received
a Temporary Assistance for Needy Families (TANF) program grant.

OAR 461-160-0430
about deductions from countable income made to determine adjusted income for
the Supplemental Nutrition Assistance Program (SNAP) is being amended to
restate when an income deduction for dependent care costs is allowed.

OAR 461-160-0530
about calculating benefits for SSI-eligible clients living in the community in
the OSIP (Oregon Supplemental Income Program) program is being repealed to make
the rules consistent with the changes to the supplemental income payment (SIP)
that were effective January 1, 2010.

OAR 461-160-0700
about how the Department uses income when determining eligibility for Oregon
Health Plan (OHP) and Healthy KidsConnect (HKC) program benefits is being
amended to state that its provisions apply to the HKC program. This rule also
is being amended to state how the Department determines the need group (the
individuals whose basic and special needs are used in determining eligibility
and benefit level) members and income when an Express Lane Agency (ELA) is
determining whether a child meets the income standard. In addition, this rule
is being amended to make permanent the temporary changes made effective August
16, 2010.

OAR 461-170-0011
about which changes in circumstances that a client must report and how the
client must report the changes is being amended to restate whose income a
Supplemental Nutrition Assistance Program (SNAP) client assigned to the
Simplified Reporting System (SRS) must report to the Department when that
income exceeds the SNAP program countable income limit.

OAR 461-175-0010
about what information a decision notice (written notice of a decision by the
Department regarding an individual’s eligibility for benefits in a program) the
Department sends to a client must include is being amended to revise the information
that a notice sent due to a mass change to payments in a program operated by
the Department must include. This rule also is being amended to make permanent
the temporary changes made to this rule effective August 16, 2010.

OAR 461-175-0200
which provides general information about the decision notices (written notices
of decisions by the Department regarding an individual’s eligibility for
benefits in a program) the Department sends to clients is being amended to
state the type of notice the Department sends and what the notice must include
when a child is found eligible for Healthy KidsConnect (HKC) program benefits
based on an Express Lane Agency (ELA) determination. This rule also is being
amended to make permanent the temporary changes made effective August 16, 2010.

OAR 461-175-0250
about the notice the Department sends to clients when making a mass change to
program eligibility or benefit levels is being amended to include mass changes
payments in a program operated by the Department. This rule also is being
amended to make permanent the temporary changes made to this rule effective
August 16, 2010.

OAR 461-193-0560
about the payment standards (used to calculate cash benefits for a client) in
the Refugee Case Services Project (RCSP) program is being amended to state the
payment standards that became effective on October 1, 2010. This rule also is
being amended to make permanent the temporary changes made to this rule
effective August 16, 2010.

Rules Coordinator: Annette Tesch—(503) 945-6067

461-001-0000

Definitions for Chapter 461

Defined terms are often italicized throughout this
chapter of rules. If a defined term is accompanied by a cross-reference to a
rule defining the term, subsequent usages of that term in the same rule refer
to the same definition cross-referenced earlier in the rule. In this chapter of
rules, unless the context indicates otherwise:

(1) A reference to Division, Adult and Family Services
Division (or AFS), Senior and Disabled Services Division (or SDSD), or any
other agency formerly part of the Department of Human Services shall be taken
to mean the Department of Human Services (DHS), except that the rule in which
reference occurs only regulates programs covered by Chapter 461 of the Oregon
Administrative Rules.

(2) A reference to an Administrator of an agency
mentioned in section (1) means the Director of DHS.

(3) “Address Confidentiality Program” (ACP) means a
program of the Oregon Department of Justice, which provides a substitute
mailing address and mail forwarding service for ACP participants who are
victims of domestic violence, sexual assault, or stalking.

(4) “Adjusted income” means the amount determined by
subtracting income deductions from countable income (see OAR 461-140-0010).
Specific rules on the deductions are found in division 461-160.

(5) “Adoption assistance” means financial assistance
provided to families adopting children with special needs. Adoption assistance
may be state or federally funded. Federal adoption assistance is authorized by
the Adoption Assistance and Child Welfare Act of 1980 (Pub. L. No. 96-272, 94
Stat. 500 (1980)). State adoption assistance is authorized by ORS 418.330 to
418.335.

(6) “Assets” mean income and resources.

(7) “Basic decision notice” means a decision notice
mailed no later than the date of action given in the notice.

(8) “Branch office” means any Department or AAA (Area
Agency on Aging) office serving a program covered by this chapter of rules.

(9) “Budgeting” means the process of calculating the
benefit level.

(10) “Budget month” means the calendar month from which
nonfinancial and financial information is used to determine eligibility and
benefit level for the payment month.

(11) “Cafeteria plan” means a written benefit plan
offered by an employer in which:

(a) All participants are employees; and

(b) Participants can choose, cafeteria-style, from a
menu of two or more cash or qualified benefits. In this context, qualified
benefits are benefits other than cash that the Internal Revenue Services does
not consider part of an employee’s gross income. Qualified benefits include,
but are not limited to:

(12) “Capital asset” means property that contributes
toward earning self-employment income, including self-employment income from a
microenterprise, either directly or indirectly. A capital asset generally has a
useful life of over one year and a value, alone or in combination, of $100 or
more.

(13) “Caretaker” means an individual who is responsible
for the care, control, and supervision of a child. The status of caretaker ends
once the individual no longer exercises care, control, and supervision of the
child for 30 days.

(14) “Caretaker relative” means a caretaker who meets
the requirements of one of the following subsections:

(a) Is one of the following relatives of the dependent
child:

(A) Any blood relative, including those of half-blood,
and including first cousins, nephews, or nieces, and individuals of preceding
generations as denoted by prefixes of grand, great, or great-great.

(B) Stepfather, stepmother, stepbrother, and
stepsister.

(C) An individual who legally adopts the child and any
individual related to the individual adopting the child, either naturally or
through adoption.

(b) Is or was a spouse of an individual listed in
subsection (a) of this section.

(c) Met the definition of caretaker relative under
subsection (a) or (b) of this section before the child was adopted
(notwithstanding the child’s subsequent adoption).

(15) “Certification period” means the period for which
a client is certified eligible for a program.

(16) “Child” includes natural, step, and adoptive
children. The term child does not include an unborn.

(a) In the ERDC program, a child need not have a
biological or legal relationship to the caretaker but must be in the care and
custody of the caretaker, must meet the citizenship or alien status
requirements of OAR 461-120-0110, and must be:

(A) Under the age of 18; or

(B) Under the age of 19 and in secondary school or
vocational training at least half time.

(b) In the GA, GAM, and OSIP programs, a child is an
individual under the age of 18.

(c) In the OHP program, child means an individual,
including a minor parent, under the age of 19.

(d) In the OSIPM and QMB programs, child means an
unmarried individual living with a parent who is:

(A) Under the age of 18; or

(B) Under the age of 22 and attending full time
secondary, post secondary or vocational-technical training designed to prepare
the individual for employment.

(17) “Community based care” is any of the following:

(a) Adult foster care - Room and board and 24 hour care
and services for the elderly or for disabled people 18 years of age or older.
The care is contracted to be provided in a home for five or fewer clients.

(b) Assisted living facility - A program approach,
within a physical structure, which provides or coordinates a range of services,
available on a 24-hour basis, for support of resident independence in a
residential setting.

(c) In-home Services - People living in their home
receiving services determined necessary by the Department.

(d) Residential care facility – A facility that
provides residential care in one or more buildings on contiguous property for
six or more individuals who have physical disabilities or are socially
dependent.

(e) Specialized living facility - Identifiable services
designed to meet the needs of individuals in specific target groups which exist
as the result of a problem, condition or dysfunction resulting from a physical
disability or a behavioral disorder and require more than basic services of
other established programs.

(f) Independent choices - In-Home Services program
wherein the participant is given cash benefits to purchase self-directed
personal assistance services or goods and services provided pursuant to a
written service plan (see OAR 411-030-0020).

(18) “Continuing benefit decision notice” means a
decision notice that informs the client of the right to continued benefits and
is mailed in time to be received by the date benefits are, or would be,
received.

(19) “Countable” means that an available asset (either
income or a resource) is not excluded and may be considered by some programs to
determine eligibility.

(20) “Custodial parents” mean parents who have physical
custody of a child. Custodial parents may be receiving benefits as dependent
children or as caretaker relatives for their own children.

(21) “Decision notice” means a written notice of a
decision by the Department regarding an individual’s eligibility for benefits
in a program.

(a) An individual who is not a caretaker relative of a
child in the household, is unmarried or married but separated, and is under the
age of 18, or 18 years of age and a full time student in secondary school or
the equivalent level of vocational or technical training; or

(b) A minor parent whose parents have chosen to apply
for benefits for the minor parent. This does not apply to a minor parent who is
married and living with his or her spouse.

(24) “Disability” means:

(a) In the SNAP program, see OAR 461-001-0015.

(b) In the REF, SFPSS, TA-DVS, and TANF programs, for
purposes other than determining eligibility:

(A) An individual with a physical or mental impairment
that substantially limits the individual’s ability to meet the requirements of
the program; or

(B) An individual with a physical or mental impairment
that substantially limits one or more major life activities, a record of such
impairment, or who is regarded as having such an impairment as defined by the
Americans with Disabilities Act (42 USC 12102; 28 CFR 35.104).

(25) “Domestic violence” means the occurrence of one or
more of the following acts between family members, intimate partners, or
household members:

(c) Committing sexual abuse in any degree as defined in
ORS 163.415, 163.425 and 163.427.

(d) Using coercive or controlling behavior.

(26) “Domestic violence shelters” are public or private
nonprofit residential facilities providing services to victims of domestic
violence. If the facility serves other people, a portion must be used solely
for victims of domestic violence.

(27) ELA means Express Lane Agency: A public agency
identified in the State Medicaid Plan or State CHIP Plan as an agency capable
of making determinations regarding one or more eligibility requirements in the
OHP-OPC, OHP-CHP, or HKC programs.

(28) ELE means Express Lane Eligibility: In the HKC,
OHP-CHP, and OHP-OPC programs, the Department’s option to rely on a
determination, made within a reasonable period, by an ELA finding that a child
satisfies the requirements for OHP-CHP or OHP-OPC program eligibility. ELE
qualifies a child for medical assistance benefits based on a finding from
another public agency, even when the other agency’s eligibility methodology
differs from that ordinarily used by the Department to determine HKC, OHP-CHP,
and OHP-OPC program eligibility.

(29) “Electronic application” is an application
electronically signed and submitted through the internet.

(30) “Eligibility” means the decision as to whether an
individual qualifies, under financial and nonfinancial requirements, to receive
program benefits.

(31) “Equity value” means fair market value minus
encumbrances.

(32) “Fair market value” means the amount an item is
worth on the open market.

(33) “Family stability” in the JOBS, Pre-TANF,
Post-TANF, SFPSS, TA-DVS, and TANF programs means the characteristics of a
family that support healthy child development, including parental mental
health, drug and alcohol free environment, stable relationships, and a
supportive, flexible, and nurturing home environment.

(34) “Family stability activity” in the JOBS, Pre-TANF,
Post-TANF, SFPSS, TA-DVS, and TANF programs means an action or set of actions
taken by the client, as specified in a case plan, intended to promote the
ability of one or both parents to achieve or maintain family stability.

(35) “Financial institution” means a bank, credit
union, savings and loan association, investment trust, or other organization
held out to the public as a place receiving funds for deposit, savings,
checking, or investment.

(37) “Income producing property” means any real or
personal property that generates income for the financial group. Examples of
income producing property are:

(a) Livestock, poultry, and other animals.

(b) Farmland, rental homes (including a room or other
space in the home or on the property of a member of the financial group),
vacation homes, condominiums.

(38) “Initial month” of eligibility means any of the
following:

(a) In all programs, the first month a benefit group
(see OAR 461-110-0750) is eligible for a program benefit in Oregon after a
period during which the group is not eligible.

(b) In all programs except the SNAP program, the first
month a benefit group is eligible for a program benefit after there has been a
break in the program benefit of at least one full calendar month. If benefits
are suspended for one month, that is not considered a break.

(c) In the SNAP program:

(A) The first month for which the benefit group is
certified following any period during which they were not certified to
participate, except for migrant and seasonal farm workers (see OAR
461-001-0015).

(B) For migrant and seasonal farmworkers, the first
month for which the benefit group is certified following any period of one
month or more during which they were not certified to participate.

(d) In the OHP program, the first month of a
redetermination or recertification period.

(e) For a new applicant to the GA, GAM, OSIP, or OSIPM
program living in a nonstandard living arrangement, for the purposes of
calculating the correct divisor in OAR 461-140-0296, the month in which the
client would have been eligible had it not been for the disqualifying transfer
of assets.

(39) “In-kind income” means income in a form other than
money (such as food, clothing, cars, furniture, and payments made to a third
party).

(40) “Legally married” means a marriage uniting a man
and a woman according to the provisions of either:

(a) The statutes of the state where the marriage
occurred;

(b) The common law of the state in which the man and
woman previously resided while meeting the requirements for common law marriage
in that state; or

(c) The laws of a country in which the man and woman
previously resided while meeting the requirements for legal or cultural
marriage in that country.

(41) “Life estate” means the right to property limited
to the lifetime of the individual holding it or the lifetime of some other
individual. In general, a life estate enables the owner of the life estate to
possess, use, and obtain profits from property during the lifetime of a
designated individual while actual ownership of the property is held by another
individual. A life estate is created when an individual owns property and then
transfers ownership to another individual while retaining, for the rest of his
or her life, certain rights to that property. In addition, a life estate is
established when a member of the financial group (see OAR 461-110-0530)
purchases a life estate interest in the home of another individual.

(42) “Lodger” means a member of the household group
(see OAR 461-110-0210) who:

(a) Is not a member of the filing group; and

(b) Pays the filing group for room and board.

(43) “Long term care” means the system through which
the Department provides a broad range of social and health services to eligible
adults who are aged, blind, or have disabilities for extended periods of time.
This includes nursing homes and state hospitals (Eastern Oregon and Oregon
State Hospitals).

(44) “Lump-sum income” means income received too
infrequently or irregularly to be reasonably anticipated, or received as a
one-time payment. Lump-sum income includes:

(a) Retroactive benefits covering more than one month,
whether received in a single payment or several payments.

(b) Income from inheritance, gifts, winnings, and
personal injury claims.

(45) “Marriage” means the union of a man and a woman
who are legally married.

(46) “Microenterprise” means a sole proprietorship,
partnership, or family business with fewer than five employees and capital
needs no greater than $35,000.

(47) “Minor parent”, in the ERDC, EXT, MAA, MAF, REF,
REFM, and TANF programs, means a parent under the age of 18.

(48) “Nonstandard living arrangement” is defined as
follows:

(a) In the GA, GAM, OSIP, OSIPM, and QMB programs, a
client is considered to be in a nonstandard living arrangement when the client
is applying for or receiving services in any of the following locations:

(A) A nursing facility in which the client receives
long-term care services paid with Medicaid funding, except this subsection does
not apply to a Medicare client in a skilled-stay nursing facility.

(B) An intermediate care facility for the mentally
retarded (ICF/MR).

(C) A psychiatric institution, if the individual is not
yet 21 years of age or has reached the age of 65.

(D) A community based care (see section (17) of this
rule) setting, except a State Plan Personal Care (SPPC) setting is not
considered a nonstandard living arrangement.

(b) In all programs except GA, GAM, OSIP, OSIPM, and
QMB, nonstandard living arrangement means each of the following locations:

(A) Foster care.

(B) Residential Care facility.

(C) Drug or alcohol residential treatment facility.

(D) Homeless or domestic violence shelter.

(E) Lodging house if paying for room and board.

(F) Correctional facility.

(G) Medical institution.

(49) “Ongoing month” means one of the following:

(a) For all programs except the OHP and SNAP programs,
any month following the initial month of eligibility, if there is no break in
the program benefit of one or more calendar months.

(b) For the OHP and SNAP programs, any month in the
certification period following the initial month of eligibility.

(50) “Parent” means the biological or legal (step or
adoptive) mother or father of an individual or unborn child.

(a) If the mother lives with a male and either she or
the male claims that he is the father of the child or unborn, and no one else
claims to be the father, he is treated as the father even if paternity has not
been legally established.

(b) A stepparent relationship exists if:

(A) The individual is legally married to the child’s
biological or adoptive parent; and

(B) The marriage has not been terminated by legal
separation, divorce, or death.

(c) A legal adoption erases all prior legal and blood
relationships and establishes the adoptive parent as the legal parent. However,
the biological parent is also considered a parent if both of the following are
true:

(A) The child lives with the biological parent; and

(B) The legal parent (the adoptive parent) has given up
care, control, and supervision of the child.

(51) “Payment month” means, for all programs except EA,
the calendar month for which benefits are issued.

(52) “Payment period” means, for EA, the 30-day period
starting with the date the first payment is issued and ending on the 30th day
after the date the payment is issued.

(53) “Periodic income” means income received on a
regular basis less often than monthly.

(54) “Primary person” for all programs except the SNAP
program, means the filing group member who is responsible for providing
information necessary to determine eligibility and calculate benefits. The
primary person for individual programs is as follows:

(a) For the EXT, MAA, MAF, and TANF programs, the
parent or caretaker relative.

(b) For the ERDC program, the caretaker.

(c) For SNAP, see OAR 461-001-0015.

(d) For the GA, GAM, OSIP, OSIPM, and QMB programs, the
client or client’s spouse.

(e) For the OHP, REF, and REFM programs, the applicant,
caretaker, caretaker relative, or parent.

(55) “Qualified Partnership Policy” means a long term
care insurance policy meeting the requirements of OAR 836-052-0531 that was
either:

(a) Issued while the client was a resident in Oregon on
January 1, 2008 or later; or

(b) Issued in another state while the client was a
resident of that state on or after the effective date of that state’s federally
approved State Plan Amendment to issue qualified partnership policies.

(56) “Real property” means land, buildings, and
whatever is erected on or affixed to the land and taxed as real property.

(58) “Safe homes” mean private homes that provide a few
nights lodging to victims of domestic violence. The homes must be recognized as
such by the local domestic violence agency, such as crisis hot lines and
shelters.

(60) “Shelter in kind” means an agency or person
outside the financial group (see OAR 461-110-0530) provides the shelter of the
financial group, or makes a payment to a third party for some or all of the
shelter costs of the financial group. Shelter-in-kind does not include
temporary shelter provided by a domestic violence shelter, homeless shelter, or
residential alcohol and drug treatment facilities or situations where no
shelter is being provided, such as sleeping in a doorway, park, or bus station.

(61) “Sibling” means the brother or sister of an
individual. “Blood related” means they share at least one biological or
adoptive parent. “Step” means they are not related by blood, but are related by
the marriage of their parents.

(62) “Spousal support” means income paid (voluntarily,
per court order, or per administrative order) by a separated or divorced spouse
to a member of the financial group (see OAR 461-110-0530).

(63) “Spouse” means an individual who is legally
married to another individual. In the ERDC and SNAP programs, spouse includes
an individual who is not legally married to another, but is presenting
themselves to the community as the husband or wife by:

(a) Representing themselves as husband and wife to
relatives, friends, neighbors, or tradespeople; and

(b) Sharing living expenses or household duties.

(64) “Stable income” means income that is the same
amount each time it is received.

(65) “Standard living arrangement” means a location
that does not qualify as a nonstandard living arrangement.

(66) “Teen parent” means, for TANF and JOBS, a parent
under the age of 20 who has not completed a high school diploma or GED.

(67) “Timely continuing benefit decision notice” means
a decision notice that informs the client of the right to continued benefits
and is mailed no later than the time requirements in OAR 461-175-0050.

(68) “Trust funds” mean money, securities, or similar
property held by a person or institution for the benefit of another person.

(69) “USDA meal reimbursements” mean cash
reimbursements made by the Oregon Department of Education for family day-care
providers who serve snacks and meals to children in their care.

(70) “Variable income” means earned or unearned income
that is not always received in the same amount each month.

(1) This rule explains who may receive continuing
benefits until a final order is issued in a contested case.

(2) Except as provided otherwise in this rule, a client
who is entitled to a continuing benefit decision notice under a rule in
division 175 of this chapter of rules may, at the option of the client, receive
continuing benefits, in the same manner and same amount, until a final order
resolves the contested case. To be entitled to continuing benefits, the client
must complete a hearing request not later than the later of:

(a) The tenth day following the date of the notice; and

(b) The effective date of the action proposed in the
notice.

(3) The continuing benefits are subject to modification
based on additional changes affecting the client’s eligibility or level of
benefits.

(4) In determining timeliness under section (2) of this
rule, delay caused by circumstances beyond the control of the claimant is not
counted.

(5) In the ERDC program, if benefits are reduced or
closed to reflect a mass change, continuing benefits are not available.

(6) In the REF and REFM programs, individuals are not
entitled to continuing benefits when the issue in question is regarding the
termination of benefits because the eligibility time period imposed by OAR
461-135-0900 has been reached.

(1) Acronyms are frequently used when referring to a
program. There is an acronym for each umbrella program (for instance, OHP) and
acronyms for each subprogram (for instance, OHP-CHP, OHP-OPC, OHP-OPP, OHP-OPU,
and OHP-OP6).

(2) When no program acronym appears in a rule in
Chapter 461 of these rules, the rule with no program acronym applies to all
programs listed in this rule. If a rule does not apply to all programs, the
rule uses program acronyms to identify the programs to which the rule applies.

(5) CAWEM; Citizen/Alien-Waived Emergent Medical.
Medicaid coverage of emergent medical needs for clients who are not eligible
for other medical programs solely because they do not meet citizenship and
alien status requirements.

(6) CEC; Continuous Eligibility for OHP-CHP pregnant
women. Title XXI medical assistance for a pregnant non-CAWEM child found
eligible for the OHP-CHP program who, for a reason other than moving out of
state or becoming a recipient of private major medical health insurance,
otherwise would lose her eligibility. The pregnant individual is deemed
eligible for OHP-CHP through the last day of the month in which the pregnancy
ends.

(7) CEM; Continuous Eligibility for Medicaid. Title XIX
medical assistance for a non-CAWEM child found eligible for Medicaid who loses
his or her eligibility for a reason other than turning 19 years of age or
moving out of state. The child is deemed eligible for Medicaid for the
remainder of the 12 month eligibility period.

(11) EXT; Extended Medical Assistance. The Extended Medical
Assistance program provides medical assistance for a period of time after a
family loses its eligibility for the MAA, MAF, or Pre-TANF program due to an
increase in their child support or earned income.

(12) GA; General Assistance. Cash assistance to
low-income individuals with disabilities who do not have dependent children.

(13) GAM; General Assistance Medical. Medical
assistance to clients who are eligible for the GA program but have not been
found eligible for OSIPM benefits.

(14) HKC; Healthy KidsConnect. A program administered
by the Office of Private Health Partnerships (OPHP) providing access to health
care for children not eligible for any of the Department’s other medical
assistance programs. The Department determines eligibility and OPHP manages
enrollment.

(15) HSP; Housing Stabilization Program. A program that
helps low-income families obtain stable housing. The program is operated
through the Housing and Community Services Department through community-based,
service-provider agencies. The Department’s rules for the program (OAR
461-135-1305 to 461-135-1335) were repealed July 1, 2001.

(16) JOBS; Job Opportunity and Basic Skills. An
employment program for REF, REFM, and TANF clients. JOBS helps these clients
attain self-sufficiency through training and employment. The program is part of
Welfare Reform.

(17) JOBS Plus. Provides subsidized jobs rather than
SNAP or TANF benefits. For TANF clients, JOBS Plus is a component of the JOBS
Program; for SNAP clients and noncustodial parents of children receiving TANF,
it is a separate employment program. Eligibility for TANF clients, SNAP
clients, and noncustodial parents of children receiving TANF is determined by
the Department. Eligibility for UI recipients is determined by the Oregon State
Employment Department. When used alone, JOBS Plus includes only clients whose
JOBS Plus program participation is through the Department of Human Services.
JOBS Plus administered through the Oregon State Employment Department is known
in chapter 461 of the Oregon Administrative Rules as Oregon Employment
Department UI JOBS Plus. The following acronyms are used for specific
categories:

(a) TANF-PLS; Clients eligible for JOBS Plus based on
TANF.

(b) SNAP-PLS; Clients eligible for JOBS Plus based on
SNAP.

(c) NCP-PLS; Noncustodial parents of children receiving
TANF.

(18) LIS; Low-Income Subsidy. The Low-Income Subsidy program
is a federal assistance program for Medicare clients who are eligible for extra
help meeting their Medicare Part D prescription drug costs.

(19) MAA; Medical Assistance Assumed. The Medical
Assistance Assumed program provides medical assistance to people who are
eligible for the Pre-TANF program or ongoing TANF benefits.

(20) MAF; Medical Assistance to Families. The Medical
Assistance to Families program provides medical assistance to people who are
ineligible for MAA but are eligible for Medicaid using ADC program standards
and methodologies that were in effect as of July 16, 1996.

(21) OFSET. The Oregon Food Stamp Employment Transition
Program, which helps SNAP program benefit recipients find employment. This
program is mandatory for some SNAP program benefit recipients.

(22) OHP; Oregon Health Plan. The Oregon Health Plan
Program provides medical assistance to many low-income individuals and
families. The program includes five categories of people who may qualify for
benefits. The acronyms for these categories are:

(a) OHP-CHP; Persons Under 19. OHP coverage for persons
under 19 years of age who qualify under the 201 percent income standard.

(b) OHP-OPC; Children. OHP coverage for children who
qualify under the 100 percent income standard.

(c) OHP-OPP; Pregnant Females and their newborn
children. OHP coverage for pregnant females who qualify under the 185 percent
income standard and their newborn children.

(d) OHP-OPU; Adults. OHP coverage for adults who
qualify under the 100 percent income standard. A person eligible under OHP-OPU
is referred to as a health plan new/noncategorical (HPN) client.

(e) OHP-OP6; Children Under 6. OHP coverage for
children under age 6 who qualify under the 133 percent income standard.

(23) OSIP; Oregon Supplemental Income Program. Cash
supplements and special need payments to persons who are blind, disabled, or 65
years of age or older. When used alone, OSIP refers to all OSIP programs. The
following acronyms are used for OSIP subprograms:

(a) OSIP-AB; Oregon Supplemental Income Program —
Aid to the Blind.

(b) OSIP-AD; Oregon Supplemental Income Program —
Aid to the Disabled.

(c) OSIP-EPD; Oregon Supplemental Income Program
— Employed Persons with Disabilities program. This program provides
Medicaid coverage for employed persons with disabilities with adjusted income
less than 250 percent of the Federal Poverty Level.

(d) OSIP-OAA; Oregon Supplemental Income Program - Old
Age Assistance.

(24) OSIPM; Oregon Supplemental Income Program Medical.
Medical coverage for elderly and disabled individuals. When used alone, OSIPM
refers to all OSIP-related medical programs. The following codes are used for
OSIPM subprograms:

(a) OSIPM-AB; Oregon Supplemental Income Program
Medical — Aid to the Blind.

(b) OSIPM-AD; Oregon Supplemental Income Program
Medical — Aid to the Disabled.

(c) OSIPM-EPD; Oregon Supplemental Income Program
Medical — Employed Persons with Disabilities program. This program
provides Medicaid coverage for employed persons with disabilities with adjusted
income less than 250 percent of the Federal Poverty Level.

(d) OSIPM-OAA; Oregon Supplemental Income Program
Medical — Old Age Assistance.

(25) The Post-TANF program provides a monthly
transitional payment to employed clients who are no longer eligible for the
Pre-TANF or TANF programs due to earnings, and meet the other eligibility
requirements.

(26) The Pre-TANF program is an up-front assessment and
resource-search program for TANF applicant families. The intent of the program
is to assess the individual’s employment potential; determine any barriers to
employment or family stability; develop an individualized case plan that
promotes family stability and financial independence; help individuals find
employment or other alternatives; and provide basic living expenses immediately
to families in need.

(27) QMB; Qualified Medicare Beneficiaries. Programs
providing payment of Medicare premiums and one program also providing
additional medical coverage for Medicare recipients. Each of these programs
also is considered to be a Medicare Savings Program (MSP). When used alone in a
rule, QMB refers to all MSP. The following codes are used for QMB subprograms:

(b) QMB-DW; Qualified Medicare Beneficiaries —
Disabled Worker. Payment of the Medicare Part A premium for people under age 65
who have lost eligibility for Social Security disability benefits because they
have become substantially gainfully employed.

(c) QMB-SMB; Qualified Medicare Beneficiaries -
Specified Limited Medicare Beneficiary. Payment of the Medicare Part B premium
only. There are no medical benefits available through QMB-SMB.

(d) QMB-SMF; Qualified Medicare Beneficiaries —
Qualified Individuals. Payment of the Medicare Part B premium only. There are
no medical benefits available through QMB-SMF. This program has a 100-percent
federal match, but also has an allocation that, if reached, results in the
closure of the program.

(30) The Repatriate Program helps Americans resettle in
the United States if they have left a foreign land because of an emergency
situation.

(31) SAC; Medical Coverage for Children in Substitute
or Adoptive Care.

(32) SFDNP; Senior Farm Direct Nutrition Program. Food
vouchers for low income seniors. Funded by a grant from the United States
Department of Agriculture.

(33) SFPSS; State Family Pre-SSI/SSDI Program. A
voluntary program providing cash assistance and case management services to
families when at least one TANF eligible adult in the household has an impairment
(see OAR 461-125-0260) and is or will be applying for Supplemental Security
Income (SSI) or Social Security Disability Insurance (SSDI).

(34) SNAP; Supplemental Nutrition Assistance Program.
Helps low-income households maintain proper nutrition by giving them the means
to purchase food. SNAP used to be known as FS or Food Stamps, any reference to
SNAP also includes FS and Food Stamps.

(36) TANF; Temporary Assistance for Needy Families.
Cash assistance for families when children in those families are deprived of
parental support because of continued absence, death, incapacity, or
unemployment.

(1) The need group consists of the individuals whose
basic and special needs are used in determining eligibility and benefit level.

(2) In the EA, REF, and REFM programs, the need group
consists of the members of the financial group (see OAR 461-110-0530) who meet
all nonfinancial eligibility requirements, except that members disqualified for
an intentional program violation are not in the need group.

(3) In the ERDC, OSIP-EPD, OSIPM-EPD, QMB, and SAC
programs, the need group consists of each member of the financial group.

(4) In the EXT program, the need group consists of each
member of the financial group except an individual excluded from the need group
for not complying with social security number requirements under OAR
461-120-0210.

(5) In the SNAP program, the need group consists of the
members of the financial group who meet all nonfinancial eligibility
requirements, except the following people are not in the need group:

(a) A member disqualified for an intentional program
violation.

(b) A fleeing felon under OAR 461-135-0560.

(c) An individual violating a condition of state or
federal parole, probation, or post-prison supervision under OAR 461-135-0560.

(6) In the GA and GAM programs, the need group consists
of each member of the financial group except that the following individuals may
not be in the need group:

(a) A fleeing felon under OAR 461-135-0560.

(b) An individual in violation of a condition of state
or federal parole, probation, or post-prison supervision under OAR
461-135-0560.

(c) An individual not complying with social security
number requirements under OAR 461-120-0210.

(7) In the MAA and TANF programs, the need group is
formed as follows:

(a) Except as provided in subsection (b) of this
section, the need group consists of the members of the financial group who meet
all nonfinancial eligibility requirements other than the citizenship and alien status
requirements of OAR 461-120-0110 or the citizenship documentation requirements
of OAR 461-115-0705.

(b) The need group cannot include:

(A) A parent who is in foster care and for whom foster
care payments are being made.

(B) An unborn child.

(C) In the TANF program:

(i) An individual who cannot be in the need group
because of a disqualification penalty.

(ii) An individual who cannot be in the need group
because the individual has exceeded the 60-month time limit and does not meet
any of the exceptions listed in OAR 461-135-0075.

(iii) A fleeing felon under OAR 461-135-0560.

(iv) An individual violating a condition of state or
federal parole, probation, or post-prison supervision under OAR 461-135-0560.

(8) In the MAF program, the need group consists of the
members of the financial group who meet all nonfinancial eligibility
requirements other than the citizen and alien status requirements of OAR
461-120-0110 or the citizenship documentation requirements of OAR 461-115-0705,
except for the following individuals:

(a) A parent who is in foster care and for whom foster
care payments are being made.

(b) The father of an unborn child who has no eligible
dependent children.

(9) In the HKC and OHP programs:

(a) An unborn child of a pregnant female is included in
the need group.

(b) Except as provided in OAR 461-150-0055(5), the need
group consists of each member of the financial group except an individual
excluded from the need group for not complying with social security number
requirements under OAR 461-120-0210.

(A) When there is a parent (see OAR 461-001-0000) in
the household group (see OAR 461-110-0210), one parent.

(B) When there is no parent in the household group, the
primary person (see OAR 461-001-0000).

(c) In the ERDC program, a caretaker (see OAR 461-001-0000).

(2) In the EA program:

(a) A caretaker relative must sign the application and
complete the application process for a child (see OAR 461-001-0000). If the
child is not living with a caretaker relative, another adult may act on behalf
of the child.

(b) If the caretaker relative lives with a spouse (see
OAR 461-001-0000), both must sign the application.

(c) A dependent child 18 years of age who applies must
sign the application and complete the application process.

(3) In the GA, GAM, and QMB programs, an adult
requesting assistance and the adult's spouse, if they live together, must
complete the application process and sign the application.

(4) In the OSIP and OSIPM programs, an adult requesting
assistance and the adult's spouse, if they live together, must sign the
application and complete the application process, if able. If the client and
the spouse are unable to sign the application and complete the application
process, this can be done by the authorized representative (see 461-115-0090).
If the applicant dies prior to the determination of eligibility for OSIPM, the
application may be processed if the Department receives the required
verification.

(5) In the SNAP program, the primary person, the spouse
of the primary person, or another adult member of the filing group (see OAR
461-110-0370) must sign the application and complete the application process.

(6) An individual required to sign the application but
unable to sign may sign with a mark, witnessed by an employee of the field
office.

(1) In the CAWEM, ERDC, REF, and REFM programs, a
member of a need group (see OAR 461-110-0630) or a benefit group (see
OAR 461-110-0750) is not required to provide or apply for a social security
number (SSN). In these programs, the Department may request that a member of
the filing group or need group provide an SSN on a voluntary basis.

(2) In the EA and TA-DVS programs, an individual must
provide his or her SSN if the individual can.

(3) Except as provided in section (5) of this rule, in
the OSIP, OSIPM, and QMB programs, to be included in the benefit group,
an individual must:

(a) Provide a valid SSN for the individual; or

(b) Apply for a number if the individual does not have
a valid one and provide the SSN when it is received.

(4) Except as provided in sections (5) to (7) of this
rule, in all programs not covered by sections (1) to (3) of this rule, to be
included in the need group, an individual (other than an unborn) must:

(a) Provide a valid SSN for the individual; or

(b) Apply for a number if the individual does not have
one and provide the SSN when it is received.

(5) In the BCCM, CEC, CEM, EXT, GA, GAM, HKC, MAA, MAF,
OHP, OSIP, OSIPM, QMB, SAC, and SNAP programs, an individual is not required to
apply for or provide an SSN if the individual is:

(a) A member of religious sect or division of a
religious sect that has continuously existed since December 31, 1950; and

(b) Adheres to its tenets or teachings that prohibit
applying for or using an SSN.

(6) The requirement to apply for or provide the SSN is
delayed as follows:

(a) In the BCCM, CEC, CEM, EXT, MAA, MAF, OHP, and SAC
programs, a newborn who is assumed eligible based on the eligibility of the
mother of the newborn may receive benefits until one year of age without
meeting the SSN requirements of section (4) of this rule.

(b) In the SNAP program:

(A) An applicant eligible for expedited services may
receive his or her first full month’s allotment without meeting the SSN
requirement but must meet the requirement before receiving a second full
month’s allotment.

(B) Before applying for or providing an SSN, a newborn
may be added to an existing benefit group (see OAR 461-110-0750) for six
months following the date the child is born or until the group’s next
recertification, whichever is later.

(c) In the TANF program, without meeting the SSN
requirements of section (4) of this rule, a newborn child born in Oregon may be
added to the benefit group for six months following the child’s date of birth
or until the next redetermination of eligibility of the filing group (see OAR
461-110-0330), whichever is sooner.

(7) In the SNAP program:

(a) An individual who refuses or fails without good
cause to provide or apply for an SSN when required by this rule is ineligible
to participate. This period of ineligibility continues until the individual
provides the SSN to the Department.

(b) An individual may participate in SNAP for one month
in addition to the month of application, if the individual can show good cause
why the application for an SSN has not been completed. To continue to
participate, the individual must continue to show good cause each month until
the application for an SSN is complete with Social Security Administration.

(c) An individual meets the good cause requirement in
subsections (a) and (b) of this section if the individual provides evidence or
collateral information that the individual applied for or made every effort to
supply the Social Security Administration with the necessary information to
complete the application process. Delays due to illness not associated with a
disability (see OAR 461-001-0015), lack of transportation, or temporary absence
do not qualify as good cause under this rule.

(8) This rule authorizes or requires the collection of
an SSN for each of the following purposes.

(a) The determination of eligibility for benefits. The
SSN is used to verify income and other assets, and match with other state and
federal records such as the Internal Revenue Service (IRS), Medicaid, child support,
Social Security benefits, and unemployment benefits.

(b) The preparation of aggregate information and
reports requested by funding sources for the program providing benefits.

(c) The operation of the program applied for or
providing benefits.

(d) Conducting quality assessment and improvement
activities.

(e) Verifying the correct amount of payments,
recovering overpaid benefits, and identifying any individual receiving benefits
in more than one household.

(a) The requirements for a client participating in the
employment programs of the Post-TANF, Pre-TANF, REF, SNAP, and TANF programs.
The employment programs are the JOBS, OFSET, and REF (administered under
division 193 of these rules) employment programs.

(b) The effect of a labor strike on a client’s
eligibility for program benefits.

(2) The following definitions apply to OAR 461-130-0305
through 461-130-0335:

(a) “Exempt” means a client who the Department
determines is not mandatory for an employment program in accordance with OAR
461-130-0310.

(b) “Mandatory” means a client in the need group (see
OAR 461-110-0630) who the Department determines must participate in an
employment program in accordance with OAR 461-130-0310.

(c) “Volunteer” means a client who is not a mandatory
client and chooses to participate in an employment program.

(3) A client must provide the information necessary for
the Department to determine each of the following:

(a) The client’s participation classification (see OAR
461-130-0310);

(b) The client’s level of participation; and

(c) If applicable, whether a client had good cause (see
OAR 461-130-0327) for any failure to meet a requirement of an employment
program.

(4) In the SNAP program, a mandatory client (see OAR
461-130-0310(3)(b)) is registered for the employment program when a member of
the filing group (see OAR 461-110-0370) or an authorized representative (see
OAR 461-115-0090 and 461-115-0140) signs the SNAP program application.

(a) The Department assigns a client to one or more
employment program participation classifications — exempt, mandatory, and volunteer (see OAR 461-130-0305 for definitions of all three terms).

(b) In the Post-TANF program, a client is classified as
a volunteer.

(2) In the Pre-TANF, REF, and TANF programs:

(a) A client is exempt from employment program
participation and disqualification if the client meets the requirements of at
least one of the following paragraphs. The client is:

(A) Pregnant and in the month before the month in which
the due date of the pregnancy falls.

(B) A parent (see OAR 461-001-0000) during the first
six months after the birth of the parent’s dependent child (see OAR
461-001-0000) except that the Department may require the parent to participate
in parenting classes or a family stability activity (see OAR 461-001-0000). An
exemption allowed under this paragraph may apply only to one mandatory
participant in each filing group.

(C) Under 20 years of age during the first 16 weeks
after giving birth except that the client may be required to participate in
suitable activities with a preference for educational activities, parenting
classes, and family stability activity.

(D) A parent providing care for a family member who is
an individual with a disability (see OAR 461-001-0000) and is in the household
group (see OAR 461-110-0210) with the parent.

(E) An REF client 65 years of age or older.

(F) A TANF client 60 years of age or older.

(G) A noncitizen who is not authorized to work in the
United States.

(H) An individual who is eligible for and receives
supplemental security income (SSI) from the Social Security Administration.

(I) A caretaker relative (see OAR 461-001-0000) who is
non-needy.

(J) A client whose participation is likely to cause
undue hardship or is contrary to the best interests of the dependent child or
needy caretaker relative.

(K) A pregnant client who participates more than 10
hours per week during the two months before the month in which the pregnancy
due date falls.

(L) A VISTA volunteer.

(b) A parent of a dependent child who receives REF or
TANF program benefits is mandatory if the parent is in the same filing group
(see OAR 461-110-0330) with the dependent child (even if the parent is not in
the REF or TANF program benefit group under OAR 461-110-0750), unless the
parent is otherwise exempt from participation under subsection (a) of this
section.

(3) In the SNAP program:

(a) A client is exempt from employment program
participation and disqualification if the client meets the requirements of one
of the following paragraphs. The client is --

(A) Working a minimum of 30 hours a week or earning
money equal to at least the federal minimum wage multiplied by 30 hours per
week multiplied by 4.3 weeks. A self-employed client with allowable costs must
meet the earnings threshold after allowing the 50 percent deduction. This
includes migrant and seasonal farm workers (see OAR 461-001-0015) who are under
contract or similar agreement with an employer or crew chief to begin
employment within 30 days.

(B) An individual with a physical or mental condition that
prevents performance of any work.

(C) Responsible for the care of a child in the
household under 6 years of age or an individual in the household with a
disability (see OAR 461-001-0015) that substantially reduces or eliminates the
individual’s ability to care for himself or herself.

(D) Providing care for at least 30 hours a week for an
individual in another household with a disability (see OAR 461-001-0015) that
substantially reduces or eliminates the individual’s ability to care for
himself or herself.

(E) Enrolled at least half-time, as defined by the
school, in any high school or equivalent program recognized by a school
district or enrolled at least half-time in any school, training program, or
institution of higher education. Clients remain exempt during normal periods of
class attendance, vacation and recess but no longer qualify for the student
exemption when a break in enrollment occurs due to graduation, suspension or
expulsion or when the student drops out of school or does not enroll in classes
for the next regular school term (excluding summer term).

(F) Receiving REF or TANF program benefits, while a
mandatory participant in the JOBS or NAES programs.

(G) In receipt of unemployment insurance benefits or
has completed an application for unemployment insurance benefits and is waiting
for an initial decision on the claim.

(H) Participating in a drug or alcohol treatment and
rehabilitation program.

(I) Pregnant.

(J) Lacking adequate dependent care.

(K) Without adequate transportation available.

(L) Experiencing a barrier to employment, such as being
homeless or having a short-term physical or mental limitation or a serious
family problem.

(b) A mandatory client is an individual in the need
group (see OAR 461-110-0630); who is 16 or 17 years of age and a primary person
(see OAR 461-001-0015), or 18 years of age and older and 59 years of age and
younger; and who is not exempt under subsection (a) of this section.

(d) Notify the Department’s case manager or the JOBS
contractor of the reason for not keeping employment-related appointments and
interviews, not attending scheduled classes and activities, or not completing
case management activities. Notification must be made within three working days
from the date of a missed appointment, interview, class, or activity.

(e) Provide the Department, in the manner the
Department requires, with verifiable documentation of JOBS participation hours,
including paid work, job search, and educational participation hours.

(f) In the SNAP program, complete all work activities
and components specified on the case plan (see OAR 461-001-0020).

(2) In the Pre-TANF, REF, and TANF programs a mandatory
client who fails to meet a participation requirement without good cause (see
OAR 461-130-0327) is subject to disqualification in accordance with OAR
461-130-0330 only after the re-engagement process under OAR 461-190-0231 has
been completed.

In a Department employment program administered under
these rules (OAR 461-130-0305 to 461-130-0335):

(1) The Department does not require a client to provide
verification of good cause if providing the verification would expose the
client to increased risk of domestic violence (see OAR 461-001-0000).

(2) If in making a determination under this rule a
client’s physical or mental impairment is in question, the Department may
require the client to provide documentation from a qualified and appropriate
medical professional.

(3) A client is excused for good cause from a failure
to comply with a requirement of an employment program, including an activity in
a case plan (both terms defined in OAR 461-001-0025) in the following
circumstances:

(a) Participation in a required activity in a case plan
would have an adverse effect on or risk to the client’s physical or mental
health or would expose the client to increased risk of domestic violence (see OAR 461-001-0000).

(b) Except in the SNAP program, participation is likely
to cause undue hardship for the dependent child (see OAR 461-001-0000) or the
client.

(c) Appropriate child care, or day care for an
individual in the household who has a disability (see OAR 461-001-0000 and
461-001-0015 as applicable) that substantially reduces or eliminates the
individual’s ability to care for himself or herself, cannot be obtained.
“Appropriate child care” means that:

(A) Both the provider and the place where care is
provided meet health, safety, and provider requirements as required in OAR
461-165-0180;

(B) The care accommodates the parent’s work schedule;
and

(C) The care meets the specific needs of the dependent
child, such as age and special-needs requirements.

(d) The work attachment position or employment offered
is vacant due to a strike, lockout, or other labor dispute.

(e) The work attachment position or employment requires
the client to join a union, and the client has religious objections to unions.

(f) The client belongs to a union and the employment
violates the conditions of the client’s membership in the union.

(g) The wage for the client’s current or potential job
is:

(A) Less than applicable minimum wage; or

(B) If minimum wage laws do not apply, the wage (rate
for piece work) is less than that normally paid for similar work.

(h) The client’s prospective employer engages in
employment practices that are illegally discriminatory on the basis of age,
sex, race, religious or political belief, marital status, disability, sexual
orientation, or ethnic origin.

(i) The client’s participation in a required activity
in a case plan would prevent or interfere with the client’s participation in an
activity of the Grande Ronde Tribe’s NEW program.

(j) The client’s failure to participate is due to a
circumstance beyond his or her reasonable control.

(k) When the failure to comply is caused by an aspect
of the client’s disability, including the Department’s failure to provide a
reasonable accommodation.

(l) The client quits a job to accept another job with a
monthly income at least equal to the monthly income of the first job.

(4) In the SNAP program, a client is excused from not
accepting employment or for leaving a job under the following circumstances:

(a) The hours or nature of the job interferes with the
client’s religious observances, convictions, or beliefs.

(b) The client accepts employment or enrolls at least
half-time in any recognized school, training program, or institution of higher
education that requires the client to quit a job.

(c) A client accepts employment or enrolls in school in
another county, requiring the benefit group to move and the client to quit a
job.

(d) A client less than 60 years of age resigns, and the
employer recognizes the resignation as retirement.

(e) The client leaves a job to follow a type of
employment that moves from one area to another, such as migrant labor or
construction.

(f) The client accepts a job that, for reasons beyond
the control of the client, does not materialize or results in fewer work hours
or a lower wage than the client’s previous job.

(g) Work demands or conditions, such as not being paid
for work or not being paid on schedule, make employment unreasonable.

(h) The wage for the client’s current or potential job
is less than applicable minimum wage or, if minimum wage laws do not apply, the
wage (rate for piece work) is less than that normally paid for similar work.

(i) The work schedule for the job in question does not
conform to hours customary to the occupation or the hours worked each week are
more than those customary to the occupation.

(j) The client is not obligated to accept a job during
the first 30 days of registration for employment if the job is not in the
client’s field of experience.

(k) The client has no means of transportation and would
have to walk an unreasonable distance to meet the participation requirement. An
“unreasonable distance” is a distance that requires a commute of more than two
hours each day. The client must make a good-faith effort to secure the needed
transportation.

(l) Lack of adequate child care for a child who is six
years of age or older and less than 12 years of age.

(1) For the purposes of this rule, “striker” means
anyone participating in a strike or concerted stoppage of work by employees
(including a stoppage by reason of the expiration of a collective-bargaining
agreement) or any concerted slowdown or other concerted interruption of
operations by employees. An individual is not a striker if the individual is:

(a) An employee affected by a lockout;

(b) An individual who goes on strike but who is exempt (see OAR 461-130-0305) from participating in an employment program under this
division of rules the day prior to the strike, unless exempt solely on the
ground that the individual is employed; or

(c) A client who is not part of a bargaining unit on
strike and does not want to cross a picket line due to fear of personal injury
or death.

(2) In the EA, EXT, MAA, MAF, REF, and TANF programs, a
filing group is ineligible for program benefits during any month in which a parent (see OAR 461-001-0000) in the filing group is a striker. If any other member of
the filing group is a striker, only that individual is ineligible.

(3) In the SNAP program:

(a) A household containing a striker is not eligible to
participate in the program unless the household was eligible for benefits the
day prior to the date the member became a striker.

(b) An eligible household is not entitled to an
increased allotment as the result of a decrease in the income of a need group
(see OAR 461-110-0630) member on strike.

(c) The eligibility of a filing group (see OAR
461-110-0370) containing a striker is determined by adding to the income of the
group’s members who are not strikers the greater of the striker’s current
income or the striker’s income immediately before the strike. Deductions used
to determine benefits and eligibility for a household subject to the net income
eligibility standard are calculated for the month of application as for any
other household.

(d) A striker is subject to the registration requirements
of this division of rules unless exempt from participating in an employment
program on the day of application.

(1) In the Post-TANF, Pre-TANF, REF, SNAP, and TANF
programs, the Department may not disqualify from program benefits a client who
is a volunteer (see OAR 461-130-0305) participant in an employment
program.

(2) In the Pre-TANF, REF, and TANF programs, a mandatory (see OAR 461-130-0305) client who fails to comply with an employment program
participation requirement and does not have good cause (see OAR 461-130-0327)
for the failure to comply is subject to disqualification under this rule only
after the requirements of all of the following subsections are met:

(a) The client has had the opportunity to participate
in the re-engagement process under OAR 461-190-0231;

(b) The Department has determined the client is
willfully non-compliant and does not have good cause for failing to comply with
a requirement of the program;

(c) The Department has offered (and the client has
refused) or conducted screenings (and assessed if appropriate) for physical or
mental health needs, substance abuse, domestic violence, and learning needs;

(d) The Department has determined the client has no
barriers (see OAR 461-001-0025) or refuses to take appropriate steps to address
identified barriers;

(e) The Department has determined the client has not
met federally required participation rates (see OAR 461-001-0025); and

(f) The Department has assessed for any risk of harm
posed to the children by a reduction in cash assistance.

(3) The effects of a JOBS disqualification are
progressive. There are four levels of disqualification and one month of disqualification
for each level. Once a disqualification is imposed, it affects benefits
according to the following schedule until the disqualification ends in
accordance with OAR 461-130-0335:

(a) At the first through third levels, the penalty is
removal of the disqualified client from the need group (see OAR 461-110-0630).

(b) At the fourth level, the need group receives no
cash benefit in the TANF program.

(4) In the SNAP program:

(a) A mandatory client who fails to comply with the
requirements of an employment program is subject to disqualification. A
disqualified client is removed from the need group until he or she meets the
employment program requirements and serves the applicable progressive
disqualification under the following subsections:

(A) One calendar month for the first failure to comply.

(B) Three calendar months for the second failure to
comply.

(C) Six calendar months for the third and subsequent
failures to comply.

(b) A client who is exempt (see OAR 461-130-0305) from
participation in the SNAP employment program because he or she is a mandatory
participant in the JOBS program, receiving unemployment compensation benefits,
or has applied for unemployment compensation benefits and is waiting on an
initial decision must comply with the requirements of those programs. If the
client fails to comply with the requirements of the applicable program the
client is disqualified from receiving SNAP benefits, unless he or she can show
good cause under OAR 461-130-0327.

(1) An applicant who would be subject to an employment
program disqualification under OAR 461-130-0330 but withdraws the application
before benefits are approved is not subject to disqualification.

(2) In the SNAP and TANF programs, a filing group (see
OAR 461-110-0330 and 461-110-0370) is not subject to the impact of a
disqualification for a disqualified member who has left the household. Should
the member join another filing group, that group is subject to the
member’s most recent disqualification.

(3) In the SNAP program, the disqualification ends the
first day of the month following the month in which information is provided to
the Department justifying the change in the client’s participation
classification, even if the date falls within the disqualification period
provided in OAR 461-130-0330(4).

(4) In the REF and TANF programs, a client disqualified
for failure to meet the requirements of an employment program under division
190 of these rules must cooperate for two consecutive weeks with each activity
(see OAR 461-001-0025) specified in the client’s current or revised case plan
(see OAR 461-001-0025) before the Department may remove the disqualification.
Cash benefits are restored effective the date the client completes the two
consecutive week cooperation period.

(5) In the REF and TANF programs, a disqualification
ends when the Department changes the participation classification of the
disqualified individual to exempt (see OAR 461-130-0305) or when the
client complies with the requirements of the employment program (see section
(4) of this rule).

(1) This rule sets out when a client is assumed
eligible for certain medical programs because the client receives or is deemed
to receive benefits of another program.

(2) A pregnant woman who is eligible for and receiving
benefits the day the pregnancy ends is assumed eligible for the EXT, MAA, MAF,
OHP (except OHP-CHP), OSIPM, or SAC program until the last day of the calendar
month in which the 60th day after the last day of the pregnancy falls.

(3) A pregnant woman who was eligible for and receiving
medical assistance under any Medicaid program and becomes ineligible while
pregnant is assumed eligible for Medicaid until the last day of the calendar
month in which the 60th day after the last day of the pregnancy falls.

(4) A child (see OAR 461-001-0000) born to a
mother eligible for and receiving EXT, MAA, MAF, OHP (except OHP-CHP), OSIPM,
or SAC benefits is assumed eligible for medical benefits under this section
until the end of the month the child turns one year of age.

(5) The following children are assumed eligible for
SAC:

(a) A child who is the subject of an adoption
assistance agreement with another state.

(b) A child in a state subsidized, adoptive placement,
if an adoption assistance agreement is in effect between a public agency of the
state of Oregon and the adoptive parents that indicates the child is eligible
for Medicaid.

(6) The individuals described in subsection (a) and (b)
of this section are assumed eligible for OSIPM (except OSIPM-EPD) unless
subsection (c) or (d) of this section applies:

(a) A recipient of SSI benefits.

(b) An individual deemed eligible for SSI under
Sections 1619(a) or (b) of the Social Security Act (42 U.S.C. 1382h(a) or (b)),
which cover individuals with disabilities whose impairments have not changed
but who have become gainfully employed and have continuing need for OSIPM.

(c) An individual described in subsection (a) or (b) of
this section who is in a nonstandard living arrangement (see OAR 461-001-0000)
is not eligible for long-term care (see OAR 461-001-0000) services if the
individual would otherwise be ineligible for OSIPM due to a disqualifying
transfer of assets (OAR 461-140-0210 to 461-140-0300 regulate the effect of a
transfer of assets on a client).

(d) An individual described in subsection (a) or (b) of
the section who is in a nonstandard living arrangement is not assumed eligible
for long-term care services if countable resources exceed the limit after
performing the calculation under OAR 461-160-0580.

(7) A client who receives both benefits under Part A of
Medicare and SSI benefits is assumed eligible for the QMB BAS program.

(8) A client is assumed eligible for the REFM program
if:

(a) The client is receiving cash assistance through the
REF program;

(b) The client loses eligibility for cash assistance
through the REF program only because of income or resources;

(c) The client loses eligibility for the EXT, MAA, MAF,
or SAC programs, but still meets the requirements of the REFM program; or

(d) The client had refugee-related medical assistance
established in another state based on refugee status granted by the United
States Citizenship and Immigration Services, and moved to Oregon within the
client’s first eight months in the United States.

(1) Except as provided in section (3) of this rule, a
TANF client or caretaker relative (see OAR 461-001-0000) of a TANF client who
volunteers to comply, and continues to comply, with a case plan in the JOBS
program (see OAR 461-001-0025) may volunteer to receive an incentive payment.
The incentive payment is made to clients in the JOBS program to motivate and
recognize their progress toward employment and self-sufficiency. The incentive
payment, in the amount authorized by OAR 461 155 0035, is added to the client’s
cash grant if the client meets the requirements of this rule and volunteers to
receive the payment.

(2) A TANF client or caretaker relative of a
TANF client may not receive the incentive payment if the client’s grant is
reduced because of an intentional program violation (see OAR 461-195-0611), a
failure to comply with a requirement of the Child Support program (see OAR
461-120-0340), or a failure to comply with any other requirement of the TANF
program.

(3) All Cooperation Incentive payments end on September
30, 2010. Beginning October 1, 2010, no client in the TANF program will receive
a Cooperation Incentive Payment.

(1) The Department makes payments for child care,
including care covered by the ERDC program, subject to the provisions of
division 165 of this chapter of rules.

(2) To be eligible for ERDC, a filing group (see OAR
461-110-0350) must meet the requirements of all of the following subsections:

(a) At least one caretaker (see OAR 461-001-0000) must
receive income from employment (other than self-employment, see OAR
461-145-0910), including employment through a work study program.

(b) The filing group must include a child who needs
child care.

(c) The filing group must have an allowable child care
need as described in OAR 461 160 0040. If there are two adults required to be
in the filing group, and one of the adults is unemployed or self-employed, the
unemployed or self-employed adult is considered available to provide child
care, making the filing group ineligible, except in the following situations:

(B) The unemployed adult is unavailable to provide
child care while participating in the requirements of a case plan (see OAR
461-001-0025) other than requirements associated with post-secondary education.

(d) The filing group must use a child care provider who
meets the requirements in OAR 461-165-0160 and 461-165-0180.

(3) A filing group is not eligible for a child care
payment for more than six calendar months if the filing group is unwilling to
obtain a Certificate of Immunization Status for the child.

(4) The child care must be necessary to enable the
caretaker to remain employed (other than self-employed).

(5) A filing group is not eligible for child care when
the caretaker or parent in the filing group receives a grant for child care
from the Oregon Student Assistance Commission for any month the grant is
intended to cover, regardless of when the grant is received.

(6) To be eligible for ERDC program benefits, a new applicant
with an effective date of October 1, 2010 or later under OAR 461-180-0070 must
meet all of the requirements of sections (1) to (5) of this rule, and:

(a) At least one member of the ERDC program filing
group must have received a partial or full month of REF, SFPSS, or TANF program
cash benefits from the State of Oregon in at least one of the preceding three
months; and

(b) No member of the ERDC program filing group may be
concurrently receiving TANF program benefits except as allowed under OAR 461-165-0030.

(7) An applicant re-applying for ERDC benefits who had
a break in ERDC program benefits of 30 days or more at the time of
re-application is considered a new applicant and must meet the requirements of
sections (1) to (6) of this rule.

(8) The Department will place each applicant (including
applicants under section (7) of this rule) who is sent a decision notice (see
OAR 461-001-0000) of ineligibility for the ERDC program on a Child Care
Reservation List.

(9) An applicant selected from the Child Care
Reservation List must then submit an application for child care benefits to the
Department. The applicant has 30 days from the date on the selection letter
sent by the Department for the Department to receive the application for child
care benefits. If an applicant does not apply within the 30 days, the applicant
is removed from the Child Care Reservation List and must re-apply for the ERDC
program to be placed back on the Child Care Reservation List with a new
reservation number.

(10) An applicant with a valid and selected reservation
number from the Child Care Reservation List found eligible for ERDC program
benefits remains eligible until one of the circumstances in the following
subsections occurs:

(a) The client has a break in ERDC program benefits of
30 days or more; or

(b) The client no longer meets the ERDC program
eligibility requirements, excluding the requirement to have received REF,
SFPSS, or TANF program cash benefits from the State of Oregon in the preceding
three months.

(1) An individual is eligible for OSIPM under this rule
and the so-called Pickle amendment (Pub. L. No. 94 566, § 503, title V, 90
Stat. 2685 (1976)), if he or she meets all other eligibility requirements, and:

(a) Is receiving Social Security Benefits (SSB);

(b) Was eligible for and receiving SSI or state
supplements but became ineligible for those payments after April 1977; and

(c) Would be eligible for SSI or state supplement if
the SSB COLA increases paid under section 215(i) of the Social Security Act,
after the last month the individual was both eligible for and received SSI or a
supplement and was entitled to SSB, were deducted from current SSB benefits.

(2) The SSB amount received by the individual when he
or she became ineligible for SSI or OSIP is used as the individual’s countable
Social Security income, for the purposes of the Pickle Amendment. If the amount
cannot be determined, it is calculated in accordance with sections (3) and (4)
of this rule.

(3) Determine the month in which the individual was
entitled to Social Security and received SSI in the same month. Use the table
in section (4) of this rule to find the percentage that applies to that month.
Multiply the present amount of the individual’s Social Security benefits by the
applicable percentage. This amount, rounded down to the next lower whole
dollar, is the individual’s countable Social Security for purposes of this rule
and the Pickle Amendment. Add that figure to any other countable unearned
income plus adjusted earned income of the individual, and if the total is less
than the full SSI income standard for a single individual plus the $20 unearned
income deduction (OAR 461-160-0550), the individual is eligible for OSIPM for
purposes of this rule and the Pickle amendment. For spouses in the same
financial group (see OAR 461-110-0530), perform the above calculation for each
spouse, combine the results and add the subtotal to all other countable
unearned and adjusted earned income. If the total is less than the full SSI
standard for a couple plus the $20 unearned income deduction (OAR
461-160-0550), the couple is eligible for OSIPM for purposes of this rule and
the Pickle amendment. All other financial and non-financial eligibility
criteria must be met.

(4) The following guide contains the calculations used
to determine the SSB for prior years: [Calculations not included. See ED.
NOTE.]

In addition to eligibility requirements applicable to
the OHP program in other rules in chapter 461 of the Oregon Administrative
Rules, this rule sets out specific eligibility requirements for the OHP
program.

(1) For purposes of this rule, OAR 461-135-1101, and
461-135-1149, the term private major medical health insurance refers to health
insurance coverage that provides medical care for physician and hospital
services, including major illnesses, with a limit of not less than $10,000 for
each covered individual. This term does not include coverage under the Kaiser
Child Health Program or Kaiser Transition Program.

(2) To be eligible for the OHP program, an individual
cannot:

(a) Be receiving, or deemed to be receiving, SSI
benefits;

(b) Be eligible for Medicare, except that this
requirement does not apply to the OHP OPP program;

(c) Be receiving Medicaid through another program; or

(d) Be enrolled in a health insurance plan subsidized
by the Family Health Insurance Assistance program (FHIAP, see ORS 735.720 to
735.740).

(3) To be eligible for the OHP-OPU program, an
individual must be 19 years of age or older and may not be pregnant. An
individual eligible for the OHP-OPU program is referred to as a health plan
new/noncategorical (HPN) client. In addition to all other OHP program
eligibility requirements, an HPN client:

(a) May not be covered by private major medical health
insurance and may not have been covered by private major medical health
insurance during the six months preceding the effective date for starting
medical benefits. The six-month waiting period is waived if:

(A) The individual has a condition that, without
treatment, would be life-threatening or would cause permanent loss of function
or disability;

(B) The individual’s private health insurance premium
was reimbursed under the provisions of OAR 461-135-0990;

(C) The individual’s private health insurance was
subsidized through FHIAP or the Office of Private Health Partnerships (OPHP) in
accordance with ORS 414.231, 414.826, 414.831, and 414.839; or

(D) A member of the individual’s filing group was a
victim of domestic violence.

(D) The individual’s private health insurance was
subsidized through FHIAP or the Office of Private Health Partnerships (OPHP) in
accordance with ORS 414.231, 414.826, 414.831, and 414.839; or

(E) A member of the individual’s filing group was a
victim of domestic violence.

(8) A child who becomes ineligible for the OHP program
because of age while receiving in patient medical services remains eligible
until the end of the month in which he or she no longer receives those services
if he or she is receiving in patient medical services on the last day of the
month in which the age requirement is no longer met.

(9) In the HKC, OHP-CHP, and OHP-OPC programs, for the
Department to enroll a child in the program based on a determination made by an
ELA, the child’s parent or guardian must give consent in writing, by telephone,
orally, or through electronic signature for the child to be enrolled in the
program.

(10) The Department only may use ELE for a child in a
filing group in which no member is already receiving benefits through the CEC,
CEM, EXT, HKC, MAA, MAF, OHP-CHP, OHP-OPP, OHP-OP6, OSIPM, or SAC program.

(1) “OHP Standard Reservation List” means the list of
individuals who may be considered for the OHP-OPU program as a new applicant at
such times as the Department determines that new applicants may be added into
the program. This list is used to manage enrollment of new applicants as
defined by OAR 461-135-1102 into the program within the limits of program
authority and funding.

(2) “OHP Standard Reservation List Applicant” means an
individual who has been selected randomly under section (6) of this rule and
establishes a date of request (see OAR 461-115-0030) on or after the
date of the random selection and within 45 days from the date the Department
mails the OHP 7210R Application form as a result of the random selection.

(3) When the Department specifies that the OHP
Standard Reservation List is open, an individual is placed on the OHP
Standard Reservation List if all of the following requirements are met:

(a) The individual, or someone acting on behalf of the
individual, may request placement on the OHP Standard Reservation List by
calling the designated telephone number for the OHP Standard Reservation List or in writing. A written request must arrive through one of the following
methods:

(A) By mail to the designated mailing address for the
OHP Standard Reservation List.

(B) By fax or hand delivery to a local Department
office that receives client applications for the Oregon Health Plan.

(C) By electronic submission from the OHP website or by
e-mail to the OHP Standard Reservation List e-mail address.

(b) The full name, date of birth, and mailing address
of each individual requesting placement on the OHP Standard Reservation List
must be provided to the Department and received by the Department as described
in subsection (a) of this section before the request is considered complete.

(c) If the address of an individual changes after the
individual makes a request, the individual must provide an updated address to the
Department using a method described in subsection (a) of this section. If the
individual reports an address change to the Department in a way other than that
outlined in subsection (a) of this section, the Department cannot guarantee the
address change will be reflected in the reservation list, but will make
reasonable efforts to incorporate that address change.

(4) The following procedures apply to the OHP Standard
Reservation List:

(a) Individuals completing a request for placement on
the OHP Standard Reservation List are assigned a reservation number. All
members of an OHP filing group (see OAR 461-110-0400 for filing group
composition) requesting placement on the OHP Standard Reservation List are
assigned the same reservation number.

(b) The Department may request that individuals
voluntarily provide their social security number (prior to the OHP 7210R
Application). The Department may use the social security number for purposes of
identification to help prevent duplicate reservations. The Department may not
deny placement on the OHP Standard Reservation List because an individual does
not provide a social security number.

(c) The Department sends confirmation to individuals
who are placed on the OHP Standard Reservation List. If there is already a
reservation established, individuals who have received confirmation from the
Department need not make an additional request unless the reservation was
removed (see section (8) of this rule), already used, or withdrawn.

(5) Requesting placement on the OHP Standard
Reservation List, receiving a reservation number, or being placed on the OHP
Standard Reservation List does not constitute an application for the OHP-OPU
program or any other medical program administered by the Department. The
Department must send an individual an application for medical assistance when
the individual requests and is placed on the OHP Standard Reservation List,
must review each application received for eligibility under all medical
assistance programs, and must send a decision notice (see OAR 461-001-0000) for
each application received (to the extent required under OAR 461-115-0010(6)).
However, a new applicant as defined in OAR 461-135-1102 for the OHP-OPU program
is managed by the OHP Standard Reservation List.

(6) At such times that the Department determines that
it has the requisite authority and funding and that new applicants can be added
to the OHP-OPU program, and after the Department determines the number of new
applicants that can be added, a designated number of individuals on the OHP
Standard Reservation List are selected randomly and mailed OHP 7210R
Application forms. Once an individual has been selected randomly, the
reservation number assigned to that individual and its position on the list has
been used and is no longer available.

(7) An OHP Standard Reservation List Applicant must
file a Department application or amend a completed application (see OAR
461-115-0050) as a prerequisite of receiving OHP-OPU program benefits.

(8) When the Department determines that the OHP Standard
Reservation List should be discontinued, all individuals currently on the list
are removed except as provided in section (9) of this rule. If the Department
establishes a new OHP Standard Reservation List, the Department determines when
an individual may again request placement on the list according to sections (3)
and (4) of this rule.

(9) The Department may opt to use the reservation
number of an individual not selected randomly from a discontinued list to
create a new OHP Standard Reservation List. To be added to the new OHP Standard
Reservation List, the Department may require each individual not selected
randomly from the discontinued OHP Standard Reservation List to request
placement on the new OHP Standard Reservation List and be assigned a new reservation
number.

(10) Nothing in this rule prevents any individual from
applying for medical assistance at any time. However, new applicants as defined
in OAR 461-135-1102 for the OHP-OPU program are managed by the OHP Standard
Reservation List.

(b) Meet all TANF program eligibility requirements
(except as provided otherwise in this rule);

(c) Be receiving TANF benefits;

(d) Have an impairment that meets the requirements in OAR
461-125-0260;

(e) File an application for Supplemental Security
Income (SSI) disability benefits under the Social Security Act; and

(f) Sign an Interim Assistance Authorization
authorizing the Department to recover interim SFPSS program benefits paid to
the client (or paid to providers on the client’s behalf) from the initial SSI
payment or the initial payment after the decision on SSI eligibility. The
following provisions are considered part of the Interim Assistance
Authorization:

(A) Interim SFPSS program benefits include only those
SFPSS program cash benefits paid to the adult, who is applying for SSI, during
the period of time that the SSI benefit covers.

(B) For any month in which SSI is prorated, the
Department may recover only a prorated amount of the interim SFPSS program cash
benefit.

(C) If the Department does not stop delivery of an
SFPSS program benefit issued after the SSI payment is made, the SFPSS program
payment is included in the interim assistance reimbursement to the Department.

(2) Counting earned and unearned income.

(a) The TANF standards in OAR 461-155-0030 are used to
determine eligibility for the SFPSS program.

(b) The SFPSS payment standard (see OAR 461-155-0320)
is used to determine the benefit amount for the SFPSS program.

(3) When the only adult in the filing group (see
OAR 461-110-0330) is applying for SSI, and the child or all children in the filing
group are receiving an SSI grant, the family does not receive an SFPSS
grant. The family remains on TANF (if eligible) and receives a TANF grant.

(4) A client whose impairment no longer meets the
criteria in OAR 461-125-0260 is ineligible for SFPSS benefits.

(5) An SFPSS client found by the Social Security
Administration (SSA) not to meet disability criteria may continue receiving
SFPSS benefits until all SSA administrative appeals are exhausted.

(6) Once a client is approved for SFPSS, the client is
no longer subject to OAR 461-120-0340. The client remains exempt from OAR
461-120-0340 as long as the client is eligible for and receiving SFPSS.

(7) Each client is required to participate in the
appropriate activities the Department determines necessary, including activities
that promote family stability (see OAR 461-001-0000). The Department must
consider the needs of an individual with a disability (see OAR 461-001-0000),
and a client’s need for accommodation or modification.

(8) A client must provide the information necessary for
the Department to administer the program.

(a) The necessary information includes that needed to
determine appropriate activities for the client and to assess whether a client
had good cause (see OAR 461-130-0327) for any failure to meet a requirement of
the program.

(b) If a medical condition is in question, the
Department will assist and may require the client to provide a medical opinion
from a qualified and appropriate medical professional.

(9) The Department offers each client the opportunity
to participate in any suitable JOBS program activity (see OAR 461-001-0025).

(1) The Department does not require a client to provide
verification of good cause if providing the verification would expose the
client to increased risk of domestic violence (see OAR 461-001-0000).

(2) If in making a determination under this rule, a
client’s physical or mental impairment is in question, the Department may
require the client to provide documentation from a qualified and appropriate
medical professional.

(3) A client is excused for good cause from a failure
to comply with a requirement of the SFPSS program, including an activity (see
OAR 461-001-0025) in a case plan (see OAR 461-001-0025) in the following
circumstances:

(a) Participation in a required activity in a case plan
would have an adverse effect on or risk to the client’s physical or mental
health or would expose the client to increased risk of domestic violence (see
OAR 461-001-0000).

(b) Participation is likely to cause undue hardship for
the dependent child (see OAR 461-001-0000) or the client.

(c) When the failure to comply is caused by the failure
of the Department to timely provide or authorize a support service payment.

(d) Appropriate child care, or day care for an
individual in the household who has a disability (see OAR 461-001-0000) that
substantially reduces or eliminates the individual’s ability to care for
himself or herself, cannot be obtained. “Appropriate child care” means that:

(A) Both the provider and the place where care is
provided meet health, safety, and provider requirements as required in OAR
461-165-0180;

(B) The care accommodates the parent’s work schedule;
and

(C) The care meets the specific needs of the dependent
child, such as age and special-needs requirements.

(e) The work attachment position or employment offered
is vacant due to a strike, lockout, or other labor dispute.

(f) The work attachment position or employment requires
the client to join a union, and the client has religious objections to unions.

(g) The client’s participation in a required activity
in a case plan would prevent or interfere with the client’s participation in an
activity of the Grande Ronde Tribe’s NEW program.

(h) The client’s failure to participate is due to a
circumstance beyond his or her reasonable control.

(i) When the failure to comply is caused by an aspect
of the client’s disability, including the Department’s failure to provide a
reasonable accommodation.

(j) The client quits a job to accept another job with a
monthly income at least equal to the monthly income of the first job.

(k) An individual separated from his or her most recent
employment for circumstances the Department determines are reasonable.

(1) This rule explains specific requirements for the
Post-TANF program. Through September 30, 2010, the Post-TANF program provides
$100 per month per qualifying adult in aid for 12 consecutive months or until
the household income exceeds 250 percent of the Federal Poverty Level (FPL),
whichever comes first, as long as the client meets JOBS federally required
participation rates (see OAR 461-001-0025) in combined unsubsidized paid work
and JOBS activities.

(2) Effective October 1, 2010, the Post-TANF program
provides $50 per month per qualifying adult in aid for 12 consecutive months or
until the household income exceeds 250 percent of the FPL, whichever comes
first, as long as the client meets JOBS federally required participation rates
in combined unsubsidized paid work and JOBS activities.

(3) To enroll in the Post-TANF program, a client must:

(a) Have obtained unsubsidized paid employment;

(b) Have become ineligible for the Pre-TANF, TANF or
SFPSS programs due to earnings; and

(c) Be a Work Eligible Individual as defined by federal
regulations.

(4) To remain eligible for the monthly Post-TANF
payment, the client must meet the requirements of all of the following
subsections:

(a) Meet all TANF eligibility requirements, except the
client need not meet the following requirements:

(A) OAR 461-120-0310 and 461-120-0340 (child support
assignment and cooperation);

(B) OAR 461-120-0330 (pursuing assets);

(C) OAR 461-125-0010 (deprivation);

(D) OAR 461-155-0030 (income limits); and

(E) OAR 461-160-0015 (resource limits).

(b) Report and meet the monthly JOBS federal
participation requirements with unsubsidized paid work and, if necessary, other
JOBS activities.

(c) Provide the Department with employer-produced
documents of paid, unsubsidized work hours within 45 days after Pre-TANF, TANF,
or SFPSS has ended.

(d) The client must also provide employer-produced
documents of paid, unsubsidized work hours each time requested by the
Department or no later than the last day of the sixth month following the date
the client provides the verification of work hours in accordance with
subsection (c) of this section.

(e) Report all changes in residency and household group
(see OAR 461-110-0210) affecting Post-TANF eligibility within 10 days of the
occurrence.

(f) Changes reported for another program that affect
Post-TANF eligibility are considered reported for Post-TANF.

(5) A client failing to comply with subsection (3)(c)
of this rule but then providing documents after 45 days is eligible for
Post-TANF payments only in the month the local Department office receives the
documents and the months thereafter.

(6) Household income for the Post-TANF program is
calculated in accordance with all TANF financial rules.

(7) Each parent (see OAR 461-001-0000) of a two-parent
family is entitled to a monthly Post-TANF payment if both parents meet all
Post-TANF enrollment and eligibility requirements.

(8) Monthly payments in the Post-TANF program begin the
month after the last regular TANF benefit payment; or for Pre-TANF clients, the
month after the Department verifies that the client meets TANF eligibility
requirements.

(9) A client in the Post-TANF program is entitled to
support services in accordance with OAR 461-190-0241. Additional support
services may be granted with manager approval.

(10) A client is no longer eligible for a Post-TANF
payment when the client does not meet JOBS federal participation requirements
due to:

(a) Loss of employment;

(b) A reduction in work hours, and the client chooses
not to participate in required JOBS activities offered by the Department; or

(c) A reduction in JOBS activity hours without good
cause (see OAR 461-130-0327) that when combined with work hours does not meet
the JOBS federally required participation rates.

(b) For a client reapplying at the end of an OHP
certification period (see OAR 461-001-0000), no longer eligible for his or her
current OHP program, or moving from the BCCM, EXT, GAM, MAA, MAF, OSIPM, REFM,
or SAC programs to the OHP program: the last month of the current eligibility
(see OAR 461-001-0000) period.

(c) When the Department initiates a redetermination of
eligibility, the month the Department initiates a date of request (see OAR
461-115-0030).

(d) For an individual joining a filing group (see OAR
461-110-0400), the month in which the individual requests medical benefits.

(e) For a late reapplication, the month the Department
receives the new application.

(f) For a new applicant or current recipient who is not
eligible using the budget month described in subsections (1)(a) to (1)(d) of
this rule, any month falling within 45 days after the date of request.

(2) Countable (see OAR 461-001-0000) income is
determined as follows:

(a) Income is considered available during a month under
OAR 461 140 0040.

(b) Income is not annualized, converted, or prorated.

(c) For a self employed client, countable
self-employment income is determined under OAR 461-145-0920 and 461-145-0930.

(3) Except as provided in section (5) of this rule, the
average countable income of the financial group (see OAR 461-110-0530) is
calculated as follows:

(a) The income of the financial group from the month
prior to the budget month and the actual income already received in the budget
month plus income that reasonably may be expected to be received in the budget
month is added.

(b) The total is divided by two, and the result is the
average countable income assigned to the budget month of the financial group.

(c) The average countable income of the financial group
is used to determine eligibility for OHP under OAR 461 160 0700.

(4) A change in income or resources during a
certification period (see OAR 461-001-0000) does not affect the eligibility of
the benefit group (see OAR 461-110-0750) for that certification period.

(5) In the HKC, OHP-CHP, and OHP-OPC programs, when an
ELA determination finds a child eligible for medical assistance and the child
meets all other OHP-CHP, OHP-OPC, or HKC program nonfinancial eligibility
requirements, the number of need group (see OAR 461-110-0630) members is the
same as the number of eligibility group members as determined by the ELA. The
countable income of the financial group is the same as the income amount
determined by the ELA.

(a) A child is deemed eligible for the HKC, OHP-CHP, or
OHP-OPC program as follows:

(A) If the income of the need group is below 163
percent of the federal poverty level (FPL) as listed in OAR 461-155-0180, the
Department deems the child eligible for OHP-OPC.

(B) If the income of the need group is at or above 163
percent of the FPL but under 201 percent of the FPL, the Department deems the
child eligible for OHP-CHP.

(C) If the income of the need group is at or above 201
percent of the FPL, the Department deems the child eligible for HKC.

(b) If the income of the need group is above 301
percent of the FPL, the Department determines eligibility using the standard
medical assistance eligibility determination processes.

In the MAA, MAF, REF, SAC, and TANF programs, the
income standards are as follows:

(1) The Countable Income Limit Standard is the amount
set as the maximum countable income limit.

(a) For each need group (see OAR 461-110-0630)
in the REF and TANF programs containing an adult and for all need groups in the
MAA, MAF, and SAC programs, the following table is used: [Table not included.
See ED. NOTE.]

(b) In the TANF program, a caretaker relative (see OAR
461-001-0000) other than a parent (see OAR 461-001-0000) who chooses not to be
included in the need group is subject to the “no-adult countable income limit
standard” for the need group under subsection (c) of this section. The
“non-needy countable income limit standard” for the filing group is as follows:
[Table not included. See ED. NOTE.]

(c) In the REF and TANF programs, when the need group
contains no adults, the “no adult countable income limit standard” is
calculated as follows:

(A) Refer to the Countable Income Limit Standard for
need groups with adults. Use the standard for the number of individuals in the household
group (see OAR 461-110-0210).

(B) Divide the standard in paragraph (A) of this
subsection by the number of individuals in the household group. Round this
figure down to the next lower whole number if the figure is not a whole number.

(C) Multiply the figure from paragraph (B) of this
subsection by the number of individuals in the need group. The result is the
standard.

(2) The Adjusted Income/Payment Standard is used as the
adjusted income limit and to calculate cash benefits for need groups with an
adult.

(a) For need groups containing an adult in the REF and
TANF programs and for all need groups in the MAA, MAF, and SAC programs, except
as provided otherwise in subsection (b) of this section, the following table is
used: [Table not included. See ED. NOTE.]

(b) Effective October 1, 2010, to calculate cash
benefits for a need group with an adult in the REF and TANF programs, the
following table is used: [Table not included. See ED. NOTE.]

(c) In the REF and TANF programs, when the need group
contains no adult, the No-Adult Adjusted Income/Payment Standard is calculated
as follows:

(A) Refer to the Adjusted Income/Payment Standard for
need groups with adults. Use the standard for the number of individuals in the
household group.

(B) Divide the standard in paragraph (A) of this
subsection by the number of individuals in the household group. Round this
figure down to the next lower whole number if the figure is not a whole number.

(C) Multiply the figure from paragraph (B) of this
subsection by the number of individuals in the need group.

(D) Add $12 to the figure calculated in paragraph (C)
of this subsection.

(1) The cooperation incentive is a monthly payment
added to the TANF cash grant. OAR 461 135 0210 explains who is eligible for
this incentive payment.

(2) Except as provided in section (4) of this rule,
when there is an adult in the need group, the incentive payment is based on the
number of people in the need group as follows:

(a) One person — $26

(b) Two people — $32

(c) Three people — $43

(d) Four people — $52

(e) Five people — $52

(f) Six people — $75

(g) Seven people — $75

(h) Eight or more people — $109

(3) Except as provided in section (4) of this rule,
when there is no adult in the need group, the incentive is calculated as
follows:

(a) The payment authorized by section (1) of this rule
is determined based on the number of people in the household group rather than
in the need group. For instance, if there are three people in the household
group, the amount used for this calculation is $43.

(b) The figure obtained in subsection (a) of this
section is divided by the number of people in the household group, and the
result is rounded to the next lower whole number.

(c) The figure obtained in subsection (b) of this section
is multiplied by the number of people in the need group. The result is the
incentive payment.

(4) All Cooperation Incentive payments end on September
30, 2010. Beginning October 1, 2010, no client in the REF or TANF program will
receive a Cooperation Incentive Payment.

(a) If a financial group (see OAR 461-110-0530)
contains a person with significant authority in a business entity — a
“principal” as defined in OAR 461-145-0088 — the group is ineligible if
the gross income assigned to the budget month (see OAR 461-001-0000) of the
business entity is $20,000 or more. If the need group (see OAR
461-110-0630) is not ineligible under this section, its eligibility is
evaluated under subsection (b) of this section.

(b) The countable (see OAR 461-001-0000) income
standards are as follows:

(A) Except for a child found eligible for medical
assistance based on an ELA determination, the countable income standard for
OHP-OPC and OHP-OPU is 100 percent of the federal poverty level, as listed in
OAR 461-155-0180(2), based on the size of the need group.

(B) The countable income standard for OHP-OP6 is 133
percent of the federal poverty level, as listed in OAR 461-155-0180(3), based
on the size of the need group.

(C) The countable income standard for OHP-OPP is 185
percent of the federal poverty level, as listed in OAR 461-155-0180(5), based
on the size of the need group.

(D) The countable income standard for OHP-CHP is below
201 percent of the federal poverty level, as listed in OAR 461-155-0180(7),
based on the size of the need group.

(E) The countable income standard for a child found
eligible for medical assistance based on an ELA determination is determined
under OAR 461-150-0055(5).

(2) In the REFM program, the income standard is 200
percent of the federal poverty level, as listed in OAR 461-155-0180(6), based
on the size of the need group.

(1) Except as provided in section (3) of this rule, the
following payment standards apply:

(a) When one adult in the filing group (see OAR
461-110-0330) is applying for SSI: [Table not included. See ED. NOTE.]

(b) When two or more adults in the filing group are
applying for SSI: [Table not included. See ED. NOTE.]

((2) Except as provided in section (3) of this rule,
the standard for eleven individuals or more in the need group (see OAR
461-110-0530) is the sum of the payment for ten individuals in the need group,
plus $109 for each additional individual in the need group, plus the
cooperation incentive for ten individuals in the need group.

(3) Effective October 1, 2010, the following payment
standards apply:

(a) When one adult in the filing group (see OAR
461-110-0330) is applying for SSI: [Table not included. See ED. NOTE.]

(b) When two or more adults in the filing group are
applying for SSI: [Table not included. See ED. NOTE.]

(c) The standard for eleven individuals or more in the
need group is the sum of the 43 percent SSI amount for ten individuals in the
need group, plus the payment for ten individuals in the need group, plus $110
for each additional individual in the need group.

(1) The following individuals may be eligible for a
transportation services payment:

(a) A client who receives SSI; or

(b) A client who the Department determines meets the
requirements of OAR 461-125-0370(1)(c) and has adjusted income less than the
SSI standard.

(2) Services eligible for payment under this rule are
for transportation to non-medical and non-waivered activities and resources
approved by the Department. Examples of such transportation services include,
but are not limited to: reimbursement for non-commercial transportation not
available through natural supports (limited to mileage only at the full United
States General Services Administration mileage reimbursement rate);
transportation provided by common carriers, taxicab, or bus; and assistance
with purchase of a pass for public transportation.

(3) The following items are not eligible for payment
under this rule: purchase of a vehicle; vehicle maintenance or repair;
compensation for non-commercial transportation providers (payment to
non-commercial transportation providers is limited to mileage only); and
transportation services that may be obtained through other means, such as the
State Medicaid Plan, waiver, or other public or private resources available to
the individual, including natural supports.

(4) Payment for services authorized by this rule may
not exceed $25 per month.

Use of Income and Income
Deductions When There Are Ineligible or Disqualified Group Members; SNAP

When a member of the financial group (see OAR
461-110-0530) is not in the need group (see OAR 461-110-0630), benefits in the
SNAP program are calculated as follows:

(1) If the member is a qualified non-citizen (see OAR
461-120-0125(1)(a)-(g)) who does not meet the alien status requirements, the
following procedure is used:

(a) Benefits are calculated as if the qualified
non-citizen is eligible, except that a TANF grant received by the filing group
(see OAR 461-110-0370) is prorated among the members of the financial group. A
pro rata share is counted for each financial group member who meets the
citizenship or alien status requirements.

(b) Benefits are then calculated as if the qualified
non-citizen is not a member of the filing group, except that a TANF grant
received by the filing group is prorated per section (3) of this rule. Any
income received by another member of the filing group from the qualified
non-citizen is counted as income of the financial group. No expenses paid by
the qualified non-citizen are deducted from gross income.

(c) The household’s benefits are the lesser of the
amounts calculated in subsections (a) and (b) of this section.

(2) The process described in sections (3) and (4) of
this rule is used if the member is:

(a) A non-citizen but not a qualified non-citizen;

(b) Disqualified for failing to obtain or provide a
Social Security Number; or

(c) Unwilling to disclose alien status.

(3) If the member is in a group described in section
(2) of this rule:

(a) The member’s countable (see OAR 461-001-0000)
income is prorated among the members in the financial group.

(b) The pro rata share of each individual not in the
need group is excluded.

(c) The rest of the prorated income is countable income
for the financial group.

(4) An ineligible or disqualified member covered by
section (2) of this rule is entitled to all income deductions for which the
member qualifies. When paid by the member, or billed to the member and unpaid,
deductions for shelter, child support, and dependent care are calculated as
follows:

(a) The deductions, except deductions for the utility
standard, are prorated among the members of the financial group.

(b) The prorated share of the members of the need group
is deducted.

(c) The deduction for the utility standard is made in
accordance with OAR 461-160-0420.

(5) The countable income of the following financial
group members, subject to allowable deductions, is used to determine benefits:

(a) A client disqualified for failure to comply with
the requirements of the OFSET program or because of an intentional program
violation.

(b) A client:

(A) Fleeing to avoid prosecution, or custody or
confinement after conviction, under the law of the place from which the client
is fleeing, for a crime, or attempt to commit a crime, that is a felony under
the law of the place from which the client is fleeing or that, in the case of
New Jersey, is a high misdemeanor under the law of New Jersey; or

(B) Violating a condition of probation or parole
imposed under a federal or state law.

(1) Deductions from income are subtracted from countable
income (see OAR 461-140-0010) in the following order to determine adjusted
income (see OAR 461-001-0000) for the SNAP program:

(a) An earned income deduction of 20 percent of
countable earned income. The 20 percent deduction is not taken from the wages
funded by grant diversions such as Work Supplementation wages.

(b) A standard deduction of $141 per month for a
benefit group (see OAR 461-110-0750) of one, two, or three individuals. A
standard deduction of $153 for a benefit group of four individuals. A standard
deduction of $179 for a benefit group of five individuals. A standard deduction
of $205 for a benefit group of six or more individuals.

(c) A dependent care deduction for dependent care costs
billed to a member of the financial group (see OAR 461-110-0530) and not paid
for through any other program of the Department. For the cost to be deductible
under this section, the care must be necessary to enable a member of the need
group (see OAR 461-110-0630) to--

(A) Accept or continue employment;

(B) Seek employment, including a job search that meets
the requirements of a case plan (see OAR 461-001-0020); or

(C) Attend vocational or educational training. A student
receiving educational income is entitled to a deduction only for costs not
excluded from educational income by OAR 461-145-0150.

(d) The medical deduction for elderly clients and
clients who have a disability (see OAR 461-001-0015) in the need group. The
deduction is calculated by determining the total of their deductible medical
costs (see OAR 461-160-0415) and subtracting $35. The remainder is the medical
deduction.

(e) A deduction for child support payments (including
cash medical support) a member of the household makes under a legal obligation
to a child not a member of the household group (see OAR 461-110-0210),
including payments for the current month and for payments on arrearages. Child
support is not deductible if collected by setoff through the Oregon Department
of Revenue or by interception of a federal tax refund.

(f) A shelter deduction, calculated as follows:

(A) For SNAP clients required to pay room and board in
a nonstandard living arrangement (see OAR 461-001-0000), the shelter deduction
is--

(i) The cost of room and board, minus the payment
standard for the benefit group; or

(ii) The actual room cost, if the client can prove that
the room cost exceeds the cost described in subparagraph (i) of this paragraph.

(B) For all other clients, the shelter deduction is
calculated as follows:

(i) The standard deduction and the deductions of earned
income, dependent care, court-ordered child support, and medical expenses are
subtracted from countable income. Fifty percent of the remainder is subtracted
from the shelter cost calculated in accordance with OAR 461-160-0420.

(ii) The rounded balance is the deduction, except the
deduction is limited if the filing group has no member who has a disability or
is elderly (see OAR 461-001-0015). The limit is $459.

(2) If the client cannot verify a medical or
court-ordered child-support expense or cannot verify any other expense when
asked to do so, the unverified expense is not used to calculate the deduction.
If the client provides verification, the deduction is applied when calculating
the next month’s benefits. If verification is provided within the period
authorized for processing applications (see OAR 461-115-0210), the benefits for
the initial month (see OAR 461-001-0000) are recalculated using the
deduction.

In the HKC and OHP programs, the Department uses income
to determine eligibility as follows:

(1) The average countable income of the financial
group (see OAR 461-110-0530) assigned to the budget month (see OAR
461-001-0000) is determined under OAR 461-150-0055.

(2) When an ELA is determining whether a child
qualifies under the income standard, the need group (see OAR 461-110-0630)
members and income are determined under OAR 461-150-0055(5).

(3) For each member of the need group the average
countable (see OAR 461-001-0000) income of the financial group assigned to the
budget month is compared to the applicable OHP program income standard. If the
average countable income of the financial group is below the applicable income standard
for the need group size and all other financial and non-financial eligibility
requirements are met, the need group member is eligible for OHP program
benefits. If the average countable income of the financial group equals or
exceeds the applicable OHP program income standard, the need group member is
ineligible for OHP program benefits except as provided by section (4) of this
rule.

(4) The following members of the need group who are not
eligible under section (3) of this rule are eligible for OHP program benefits
if all other financial and non-financial eligibility requirements are met and
the countable income of the financial group, received or anticipated to be
received in the budget month, is below the applicable OHP program income
standard:

(a) Specifies the date the notice is mailed, which is
the effective date for a basic decision notice (see OAR 461-001-0000).

(b) Except as provided in section (2) of this rule,
specifies the action the Department intends to take and the effective date of
the action.

(c) Specifies the reasons for the action.

(d) In the SNAP program, except as provided in
paragraph (2)(c)(B) of this rule, provides the name and phone number of the
Department staff person or identifies the office to contact for additional
information.

(e) Informs the client of the extent to which the
client has a right to a hearing before an impartial person.

(f) Specifies the method and deadline for requesting a
hearing.

(g) Informs the client of the right to representation,
including legal counsel, and the right to have witnesses testify on his or her
behalf.

(h) Provides information about the availability of free
legal help.

(i) Cites the rules that support the action.

(2) If benefits are reduced or closed to reflect
cost-of-living adjustments in benefits or any other mass change under a program
operated by a federal agency or to reflect a mass change to payments in a
program operated by the Department:

(a) The requirements in subsection (1)(b) of this rule
are optional. Instead of specifying the action the Department intends to take
and the effective date of the action, the decision notice may state all of the
following:

(A) The general nature of the change.

(B) Examples of how the change affects a client’s
benefits.

(C) The month in which the change will take place.

(b) The decision notice must also state the client’s
right to continue receiving benefits.

(c) In the SNAP program:

(A) The decision notice must also state under what
circumstances benefits will be continued pending a hearing.

(B) The requirements in subsection (1)(d) of this rule
are optional. A decision notice may indicate instead that a client may contact
a local office or worker for additional information.

(3) In the SNAP program, a continuing benefit decision
notice (see OAR 461-001-0000) and a decision notice under section (2) of this
rule also must state that the client’s household will incur a liability for any
overissued benefits if:

(1) In the EA program, a basic decision notice (see OAR 461-001-0000) is sent for all situations.

(2) In the SNAP program:

(a) A continuing benefit decision notice (see OAR
461-001-0000) is sent to cases that are recertified early to align the SNAP
certification end date with the end date of TANF or medical benefits.

(b) A basic decision notice is sent for all other
actions on applications for assistance.

(3) In the JOBS program:

(a) A basic decision notice is sent whenever a request
for a support service payment is denied.

(b) No decision notice is required if request for a
support service is approved.

(4) In the TANF program, a notice approving benefits
informs the client, within one month following eligibility determination, of
the opportunity to volunteer for JOBS participation and of the procedure for
JOBS program entry.

(5) In the Pre-TANF program, a basic decision notice is
sent when payment for basic living expenses is denied or when payment for other
support services in the JOBS program is denied. No other notices are required
for this program.

(6) In the TA-DVS program, a basic decision notice (see
OAR 461-001-0000) is sent to a safe mailing address or hand delivered for all
situations. This includes when the program is approved, denied, or closed
(prior to the end of the 90 day eligibility period) and when a payment under
the program is denied.

(7) In all programs except the Pre-TANF program, unless
stated differently in this rule or another rule, the Department mails or
otherwise provides the client with (sends) a decision notice (see OAR
461-001-0000) as follows:

(a) A basic decision notice is sent whenever an
application for assistance, including retroactive medical assistance, is
approved or denied or a request for a support service payment in the JOBS
program is denied.

(b) A timely continuing benefit decision notice (see
OAR 461-001-0000) is sent whenever benefits or support service payments
authorized by OAR 461-190-0211 are reduced or closed, or the method of payment
changes to protective, vendor, or two-party.

(8) In all programs:

(a) Notwithstanding any rule in Chapter 461, to the
extent permitted by OAR 137-003-0530, the Department may take any of the
following actions:

(A) Amend a decision notice with another decision
notice or a contested case notice.

(B) Amend a contested case notice.

(C) Delay a reduction or closure of benefits as a
result of a client’s request for hearing.

(D) Extend the effective date on a decision notice or
contested case notice.

(b) Except as provided in subsection (a) of this section
or when a delay results from the client’s request for a hearing, a notice to
reduce or close benefits becomes void if the reduction or closure is not
initiated on the date stated on the notice. If the notice is void, a new notice
is sent to inform the financial group (see OAR 461-110-0530) of a new date on
which their benefits will be reduced or closed.

(c) No decision notice is required in each of the
following situations:

(A) Benefits are ended because there is no living
person in the benefit group (see OAR 461-110-0750).

(B) A notice was sent, the client requested a hearing,
and either the hearing request is dismissed or a final order is issued.

(C) The client has signed a voluntary agreement that
qualifies as a final order under ORS 183.417(3)(b) (see OAR 461-175-0340(2)).

(D) A decision notice that included the eligibility
begin and end dates was given for TA-DVS program benefits and the 90 day
eligibility period ends.

(d) When the Department amends a decision notice with
another decision notice under subsection (a) of this section, the date of the
amended notice restarts the client’s deadlines to request a hearing or
continuing benefits, or both.

(e) When a contested case notice extends an effective
date or delays a reduction or closure, the date of the amended notice restarts
a client’s timeline to request continuing benefits.

(f) When a client has a pending hearing request or is
receiving continuing benefits, and the Department amends a notice under this
section, the client need not re-file the hearing request or renew the request
for continuing benefits.

(9) When a child is found eligible for HKC program
benefits based on an ELA determination, the Department sends a basic decision
notice which includes a statement about how the child may qualify for HKC or
OHP program benefits with a lower or no premium payment.

(1) If benefits are reduced or closed to reflect
cost-of-living adjustments in benefits or other mass change under a program
operated by a federal agency or to reflect a mass change to payments in a
program operated by the Department:

(a) Except as provided in subsection (b) of this
section, the type of decision notice (see OAR 461-001-0000) used is the same as
otherwise applies to the reduction or closure of benefits under the rules of
this division.

(b) In the SNAP program, a continuing benefits decision notice (see OAR 461-001-0000) may be used if the rules in this
division of rules would otherwise require a timely continuing benefits decision
notice (see OAR 461-001-0000).

(c) OAR 461-175-0010(2) and (3) modify the content
requirements for the decision notice that apply to other decision notices under
OAR 461-175-0010(1).

(2) In the SNAP program, no decision notice is required
when the Department makes the following mass changes:

(a) An annual adjustment to income limits, the shelter
deduction, or the standard deduction.

(1) Except as provided in section (2) of this rule, the
cash assistance payment standard amount for a client is the sum total of the
TANF payment standard under OAR 461-155-0030(2) plus the Cooperation Incentive
under OAR 461-155-0035(2).

(2) Effective October 1, 2010, the cash assistance
payment standard amount for a client is the same as the TANF payment standard
under OAR 461-155-0030(2)(b).

Subject: OAR 461-145-0140 about how the Department treats tax
credits received by a client when making eligibility and benefit level
determinations is being amended to restate how the Making Work Pay (MWP) tax
credit under the American Recovery and Reinvestment Act of 2009 (Pub. Law 11-5)
is received by a client. This rule also is being amended to remove the earned
income exclusion for General Assistance (GA), General Assistance Medical (GAM),
Healthy KidsConnect (HKC), Medical Assistance Assumed (MAA), Medical Assistance
to Families (MAF), Oregon Health Plan (OHP), Oregon Supplemental Income Program
Medical (OSIPM), or Qualified Medicare Beneficiaries (QMB) program clients who
received an MWP tax credit as the option to receive an MWP tax credit on a
monthly basis expired December 31, 2010.

OAR 461-145-0143
about how the Department treats Making Work Pay and American Recovery and
Reinvestment Act of 2009 (Pub. Law 111-5) economic recovery payments when
determining a client’s eligibility for Department program benefits is being
suspended as the federal provisions authorizing these payments expired December
31, 2010.

OAR 461-145-0220
about the treatment of a client’s home when the Department is determining a
client’s assets for individuals receiving long-term care service is being
amended to revise the policy stating when the equity value of the home is
excluded from the client’s assets.

OAR 461-155-0030
about the income standards in the Job Opportunity and Basic Skills (JOBS),
Medical Assistance Assumed (MAA), Medical Assistance to Families (MAF), Refugee
Assistance (REF), Medical Coverage for Children in Substitute or Adoptive Care
(SAC), and Temporary Assistance for Needy Families (TANF) programs is being
amended to state the countable income limit for a JOBS program filing group
(the individuals from the household whose circumstances are considered in the
eligibility determination process) with a non-custodial parent who has a
dependent child receiving TANF benefits, when both the parent and child are
residents of Oregon, for the parent to be eligible to participate in JOBS
program activities.

OAR 461-160-0015
about resource limits used in eligibility determinations for the Department’s
programs is being amended to restate the resource limits effective January 1,
2011 for clients of the Qualified Medicare Beneficiaries (QMB) program.

OAR 461-190-0211
about the payments the Department provides to clients for support services
(child care, housing, transportation, and other needs) to help a client
successfully comply with the activities in the client’s case plan is being amended
to state that a non-custodial parent of a child receiving Temporary Assistance
for Needy Families (TANF) program benefits must be in a filing group (the
individuals from the household whose circumstances are considered in the
eligibility determination process) with income below the countable income limit
standard under OAR 461-155-0030 to be eligible to receive support service
payments.

Rules Coordinator: Annette Tesch—(503) 945-6067

461-145-0140

Earned Income Tax Credit (EITC)
and Making Work Pay (MWP) Tax Credit

(1) There are federal and state earned income tax
credit (EITC) programs for low-income families.

(a) An EITC may be received in one of two ways:

(A) As one annual payment received at the time of the
normal income tax returns.

(B) As an advance in the employee’s paycheck.

(b) The EITC is excluded from assets (see OAR
461-001-0000).

(2) The American Recovery and Reinvestment Act (ARRA)
of 2009 created the Making Work Pay (MWP) tax credit. This credit applies to
tax years 2009 and 2010. An MWP tax credit is received as one annual payment at
the time of the normal income tax returns. An MWP tax credit received as a
portion of an individual’s federal tax return is excluded from assets.

The $250 economic recovery payment authorized by the
American Recovery and Reinvestment Act of 2009 is excluded income in the month
of receipt and an excluded resource in the month of receipt and for the
following nine months.

(1) Home defined: A home is the place where the filing
group lives. A home may be a house, boat, trailer, mobile home, or other
habitation. A home also includes the following:

(a) Land on which the home is built and contiguous
property.

(A) In all programs except the GA, GAM, OSIP, OSIPM,
QMB, and SNAP programs property must meet all the following criteria to be
considered contiguous property:

(i) It must not be separated from the land on which the
home is built by land owned by people outside the financial group (see OAR
461-110-0530).

(ii) It must not be separated by a public right-of-way,
such as a road.

(iii) It must be property that cannot be sold
separately from the home.

(B) In the GA, GAM, OSIP, OSIPM, QMB, and SNAP
programs, contiguous property is property not separated from the land on which
the home is built by land owned by people outside the financial group.

(b) Other dwellings on the land surrounding the home
that cannot be sold separately from the home.

(2) Exclusion of home and other property:

(a) For a client who has an initial month (see OAR
461-001-0000) of long-term care on or after January 1, 2006:

(A) For purposes of this subsection:

(i) The definition of “child” in OAR 461-001-0000 does
not apply.

(ii) “Child” means a biological or adoptive child who
is:

(I) Under age 21; or

(II) Any age and meets the Social Security
Administration criteria for blindness or disability.

(B) The equity value of a home is excluded if the
requirements of at least one of the following subparagraphs are met:

(i) The child of the client occupies the home.

(ii) The spouse of the client occupies the home.

(iii) The equity in the home is $506,000 or less, and
the requirements of at least one of the following sub-subparagraphs are met:

(I) The client occupies the home.

(II) The home equity is excluded under OAR
461-145-0250.

(III) The home is listed for sale per OAR 461-145-0420.

(iv) Notwithstanding OAR 461-120-0330, the equity in
the home is more than $506,000 and the client is unable legally to convert the
equity value in the home to cash.

(b) For all other filing groups, the value of a home is
excluded when the home is occupied by any member of the filing group.

(c) In the SNAP program, the value of land is excluded
while the group is building or planning to build their home on it, except that
if the group owns (or is buying) the home they live in and has separate land
they intend to build on, only the home in which they live is excluded, and the
land they intend to build on is treated as real property in accordance with OAR
461 145 0420.

(3) Exclusion during temporary absence: If the value of
a home is excluded under section (2) of this rule, the value of this home
remains excluded in each of the following situations:

(a) In all programs except the GA, GAM, OSIP, OSIPM,
and QMB programs, during the temporary absence of all members of the filing
group from the property, if the absence is due to illness or uninhabitability
(from casualty or natural disaster), and the filing group intends to return
home.

(b) In the SNAP program, when the financial group is absent
because of employment or training for future employment.

(c) In the GA, GAM, OSIP, OSIPM, and QMB programs, when
the client is absent to receive care in a medical institution, if one of the
following is true:

(A) The absent client has provided evidence that he or
she will return to the home. The evidence must reflect the subjective intent of
the client, regardless of the client’s medical condition. A written statement
from a competent client is sufficient to prove the intent.

(B) The home remains occupied by the client’s spouse,
child, or a relative dependent on the client for support. The child must be
less than 21 years of age or, if over the age of 21, blind or an individual
with a disability as defined by SSA criteria.

(d) In the MAA, MAF, REF, REFM, SAC, and TANF programs,
when all members of the filing group are absent because:

(A) The members are employed in seasonal employment and
intend to return to the home when the employment ends; or

(B) The members are searching for employment, and the
search requires the members to relocate away from their home. If all members of
the filing group are absent for this reason, the home may be excluded for up to
six months from the date the last member of the filing group leaves the home to
search for employment. After the six months, if a member of the filing group
does not return, the home is no longer excluded.

In the JOBS, MAA, MAF, REF, SAC, and TANF programs, the
income standards are as follows:

(1) The Countable Income Limit Standard is the amount
set as the maximum countable income limit.

(a) For each need group (see OAR 461-110-0630) in the
REF and TANF programs containing an adult and for all need groups in the MAA,
MAF, and SAC programs, the following table is used: [Table not included. See
ED. NOTE.]

(b) In the TANF program, a caretaker relative (see OAR
461-001-0000) other than a parent (see OAR 461-001-0000) who chooses not to be
included in the need group is subject to the “no-adult countable income limit
standard” for the need group under subsection (c) of this section. The
“non-needy countable income limit standard” for the filing group is as follows:
[Table not included. See ED. NOTE.]

(c) In the REF and TANF programs, when the need group
contains no adults, the “no adult countable income limit standard” is
calculated as follows:

(A) Refer to the Countable Income Limit Standard for
need groups with adults. Use the standard for the number of individuals in the
household group (see OAR 461-110-0210).

(B) Divide the standard in paragraph (A) of this
subsection by the number of individuals in the household group. Round this
figure down to the next lower whole number if the figure is not a whole number.

(C) Multiply the figure from paragraph (B) of this
subsection by the number of individuals in the need group. The result is the
standard.

(d) In the JOBS program, for the filing group of a
non-custodial parent who resides in Oregon and whose dependent child (see OAR
461-001-0000) is receiving TANF program benefits in Oregon to participate in an
activity (see OAR 461-001-0025) of the JOBS program, the countable (see OAR
461-001-0000) income limit is as follows:

(2) The Adjusted Income/Payment Standard is used as the
adjusted income limit and to calculate cash benefits for need groups with an
adult.

(a) For need groups containing an adult in the REF and
TANF programs and for all need groups in the MAA, MAF, and SAC programs, except
as provided otherwise in subsection (b) of this section, the following table is
used: [Table not included. See ED. NOTE.]

(b) Effective October 1, 2010, to calculate cash
benefits for a need group with an adult in the REF and TANF programs, the
following table is used: [Table not included. See ED. NOTE.]

(c) In the REF and TANF programs, when the need group
contains no adult, the No-Adult Adjusted Income/Payment Standard is calculated
as follows:

(A) Refer to the Adjusted Income/Payment Standard for
need groups with adults. Use the standard for the number of individuals in the
household group.

(B) Divide the standard in paragraph (A) of this
subsection by the number of individuals in the household group. Round this
figure down to the next lower whole number if the figure is not a whole number.

(C) Multiply the figure from paragraph (B) of this
subsection by the number of individuals in the need group.

(D) Add $12 to the figure calculated in paragraph (C)
of this subsection.

(a) $10,000 for a need group with at least one
JOBS participant who is progressing in a case plan.

(b) $10,000 for a need group with at least one member
who is working under a JOBS Plus agreement.

(c) $2,500 for all other need groups, including
all TANF applicants.

(5) In the OHP program, the resource limit for an
individual whose eligibility is determined under the OHP-OPU program is $2,000.

(6) In the QMB program, the resource limit is amended
in January of each year based on the low income subsidy for Medicare Part D as
published by the Health Resources and Services Administration of the U.S.
Department of Health and Human Services. Effective January 1, 2011 the resource
limit is $6,680 for a one-person need group and $10,020 for a need group
containing two or more individuals.

(7) In the SNAP program, the resource limit is:

(a) $3,000 for a financial group (see OAR
461-110-0530) with at least one member who is elderly (see OAR 461-001-0015) or
an individual with a disability (see OAR 461-001-0015).

(1) The Department helps an individual comply with the
individual’s case plan (see OAR 461-001-0025) by providing payments for child
care, housing, transportation, and other needs to make participation in a
required activity (see OAR 461-001-0025) successful. These payments are
provided for costs directly related to participation in an activity, for costs
necessary to obtain and retain a job, and for enhancing wages and benefits. In
approving JOBS program support service payments, the Department must consider
lower cost alternatives. It is not the intent of the Department or of this rule
to supplant Department funding with other funding that is available in the
community. It is the Department’s expectation that case managers and clients
will work collaboratively to seek resources that are reasonably available to
the client in order to participate in activities.

(2) Support service payments must be authorized in
advance and are subject to the limitations of this rule. The following
standards apply to support service payments.

(3) Subject to the limitations of state funding,
payments for support services (see OAR 461-001-0025) will be made available to
an individual if all of the following requirements are met:

(a) The individual is one of the following:

(A) A TANF program applicant or recipient.

(B) A client in the Pre-TANF, Post-TANF, or SFPSS
programs.

(C) A minor parent (see OAR 461-001-0000) who has
returned to the minor’s parent’s home in the last 40 days, if the move caused
the client to become ineligible for TANF program benefits.

(D) A TANF program client participating in diagnosis,
counseling, or treatment programs for substance abuse or mental health.

(E) A non-citizen who is ineligible for the TANF
program, who is legally able to work in the United States, and who has a child
receiving TANF program benefits.

(F) An individual disqualified from the TANF program
for failure to comply with the child-support related requirements of OAR
461-120-0340 and 461 120-0345.

(I) A non-custodial parent (see OAR 461-001-0000) of a
child receiving TANF program benefits, if both are residents of Oregon and the
income of the filing group of the non-custodial parent is below the countable
(see OAR 461-001-0000) income limit standard under OAR 461-155-0030.

(J) A recipient of supplemental security income (SSI)
who is a volunteer (see OAR 461-130-0310) in an employment program.

(K) A caretaker relative (see OAR 461-001-0000) who is
non-needy and is a volunteer in an employment program.

(b) The individual has agreed to participate in a JOBS
program activity or another approved activity as specified in the individual’s
case plan.

(4) For an individual who is eligible for a support
service payment under paragraphs (3)(a)(J) and (3)(a)(K) of this rule, the
Department will consider that individual’s income and resources towards the
need.

(5) Denials and Reductions. The Department may reduce,
close, or deny in whole or in part an individual’s request for a support
service payment in the following circumstances:

(a) If the individual is disqualified for failing to
comply with a case plan, unless the payment in question is necessary for the
client to comply with his or her case plan.

(b) If the purpose for the payment is not related to
the individual’s case plan.

(c) If the client disagrees with a support service
payment offered or made by the Department as outlined in the client’s case plan.

(6) Required Verification.

(a) The Department may require the individual to
provide verification of a need for the support service prior to approval and
issuance of payment if verification is reasonably available.

(b) The Department may require the individual to
provide verification of costs associated with a support service if verification
is reasonably available.

(7) Child Care. Payments for child care are authorized,
as limited by OAR 461 160 0040, if necessary to enable the individual to
participate in a JOBS program or another approved activity specified in the
individual’s case plan. If authorized, payment for child care will be made for:

(a) The lesser of the actual rate charged by the care
provider and the rate established in OAR 461-155-0150. The Department rate for
children in care less than 158 hours in a month is limited by OAR 461-155-0150,
except that the cost of child care may be paid up to the monthly maximum when
children are in care less than 158 hours per month and---

(A) Appropriate care is not accessible to the
individual at the hourly rate; or

(B) The individual is a teen parent using on-site care
while attending education activities.

(b) The minimum hours necessary, including meal and
commute time, for the individual to participate in a JOBS program or another
approved activity or to obtain and perform employment duties.

(8) Child care payments may be provided when an
individual is not participating in an activity of the JOBS program or another
approved activity if necessary for the individual to retain a child care
provider. Only the minimum amount necessary to maintain the child care slot
with the provider may be covered as established in OAR 461-155-0150. Not more
than 30 days between a scheduled JOBS program or another approved activity may
be covered.

(9) Housing and Utilities. In addition to payments for
basic living expenses provided in OAR 461-135-0475, payments may be provided to
secure or maintain housing and utilities in the following situations:

(a) To prevent an eviction or utility shut-off, secure
housing in order to find or maintain employment, or participate in an activity
listed in the individual’s case plan. Payment is available when the
requirements of all of the following paragraphs are met:

(A) The individual cannot make a shelter or utility
payment due to lack of assets.

(B) The lack of assets did not result from a JOBS
program or Child Support disqualification, a reduction due to an IPV recovery,
overpayment recovery (other than administrative error), or failure by the
individual to pay shelter or utility expenses when funds were reasonably
available.

(C) The individual’s case plan addresses how subsequent
shelter or utility payments will be made.

(b) The shelter need results from domestic violence
(see OAR 461-001-0000) and the requirements of all of the following paragraphs
are met:

(A) The individual is not eligible for the TA-DVS
program.

(B) The individual will be able to pay all subsequent
shelter costs, either through the individual’s own resources or through other
resources available in the community.

(C) The individual’s case plan addresses how subsequent
shelter costs will be paid.

(c) For clients who are in the Pre-TANF program or are
applying for a payment under section (6) of this rule, the Department will make
payments if the client meets the eligibility criteria in section (9) of this
rule. A client who receives a TANF program grant is expected to meet the
housing and utility expenses out of the money received each month in the TANF
program grant. Therefore, for clients who receive a TANF program grant, the
Department may make payments on a case-by-case basis as appropriate if the
client otherwise meets the support service payment eligibility criteria of this
section.

(10) Transportation. The Department will provide
payments for transportation costs incurred in travel to and from a JOBS program
or another approved activity. Payment is made only for the cost of public
transportation or the cost of vehicle insurance, repairs, and fuel for a
personally owned vehicle. The Department will not authorize payment for repair
of a vehicle owned by an individual who is not in the TANF program filing group
(see OAR 461-110-0330). Payments are subject to the following considerations:

(a) Payments for public transportation are given
priority over payments for a privately owned vehicle.

(b) Payment for a privately owned vehicle is provided
if the client or driver has a valid license and either of the following is
true:

(A) No public transportation is available or the client
is unable to use public transportation because of a verifiable medical
condition or disability for which no accommodation is available.

(B) Public transportation is available but is more
costly than the cost of car repair or fuel.

(11) Other Payments. The Department will provide
payments for other items that are directly related to participation in a JOBS
program or another approved activity. Payments under this section may be
authorized for:

(C) To the extent that Department funding designated
for this purpose is available; and

(D) When the training is necessary for a job leading to
a higher wage and high demand occupation, as defined by the Workforce
Investment Act (WIA).

(12) Students Receiving Financial Aid. Authorization
for payments for students in vocational training who receive financial aid is
subject to the following conditions:

(a) A student whose financial aid consists solely of
student loans is not required to use any of that financial aid for support
services.

(b) Support service payments are not authorized for
services specifically covered by federal or state financial aid other than
student loans.

(c) Students whose financial aid consists of a
combination of loans and grants may be required to pay for support services
from any grant money remaining after payment of tuition, fees solely related to
the institution where the individual attends, books, and supplies (applying
first the loan and then any grants) if the financial aid award letter
specifically permits this use of funds.

Subject: OAR 461-150-0055 which concerns eligibility and
budgeting in the Oregon Health Plan (OHP) program is being amended to extend
changes made by temporary rule on November 1, 2010 because the underlying rule
was amended by other permanent changes effective January 1, 2011. This
amendment extends this rule to the Healthy KidsConnect (HKC) program. This rule
also is being amended to state how the Department determines the budget month
(the calendar month from which information is used to determine eligibility and
benefit level for the payment month) when the Department initiates a
redetermination of eligibility for an HKC or Oregon Health Plan (OHP) program
client by sending the client a DHS 945 form about the need to renew their
medical benefits. In addition, this rule is being amended to restate how the
Department determines the countable income of an HKC or OHP program financial
group (the individuals whose income and resources count in determining
eligibility). This rule also is being amended to clarify which standard is used
to determine eligibility for an HKC, Oregon Health Plan – Persons Under
19 (OHP-CHP), or Oregon Health Plan – Children (OHP-OPC) program client
when the Department is using an Express Lane Eligibility (ELE) finding to
determine the client’s eligibility.

OAR 461-160-0430
about deductions from countable income made to determine adjusted income for
the Supplemental Nutrition Assistance Program (SNAP) is being amended to extend
changes made by temporary rule on November 4, 2010 because the underlying rule
was amended by other permanent changes effective January 1, 2011. This
amendment revises the deduction amounts that were effective as of October 1,
2010.

OAR 461-160-0700
which concerns how the Department uses income when determining eligibility for
Oregon Health Plan (OHP) and Healthy KidsConnect (HKC) program benefits to
extend changes made by temporary rule on November 1, 2010 because the
underlying rule was amended by other permanent changes effective January 1,
2011. This amendment restates which countable income the Department uses for a
client’s budget month (the calendar month from which information is used to
determine eligibility and benefit level for the payment month). This rule also
is being amended to remove the provision about how the Department determines
the members of a need group (the individuals whose basic and special needs are
used in determining eligibility and benefit level) following an Express Lane
Agency (ELA) finding of eligibility. In addition, this rule is being amended to
remove provisions allowing the Department to make an eligibility determination
for need group members in the Oregon Health Plan – Persons Under 19
(OHP-CHP), Oregon Health Plan – Children (OHP-OPC), Oregon Health Plan
– Children Under 6 (OHP-OP6), and Oregon Health Plan – Pregnant
Females and their newborn children (OHP-OPP) programs as well as victims of
domestic violence to be eligible for OHP program benefits when the countable
income of the financial group (the individuals whose income and resources count
in determining eligibility) was below the applicable OHP program income
standard even when the average countable income of the financial group equaled
or exceeded the applicable OHP program income standard.

Rules Coordinator: Annette Tesch—(503) 945-6067

461-150-0055

Eligibility and Budgeting; HKC,
OHP

In the HKC and OHP programs:

(1) The budget month (see OAR 461-001-0000) is:

(a) For a new applicant, the month of application.

(b) For a client reapplying at the end of an OHP certification
period (see OAR 461-001-0000), no longer eligible for his or her current
OHP program, or moving from the BCCM, EXT, GAM, MAA, MAF, OSIPM, REFM, or SAC
programs to the OHP program: the last month of the current eligibility (see OAR
461-001-0000) period.

(c) When the Department initiates a redetermination of eligibility:

(A) The last month of the current eligibility period if
the Department initiates the redetermination by sending a DHS 945 form.

(B) For all cases not covered by paragraph (A) of this
subsection, the month the Department initiates a date of request (see
OAR 461-115-0030).

(d) For an individual joining a filing group (see OAR 461-110-0400), the month in which the individual requests medical
benefits.

(e) For a late reapplication, the month the Department
receives the new application.

(f) For a new applicant or current recipient who is not
eligible using the budget month described in subsections (1)(a) to (1)(d) of
this rule, any month falling within 45 days after the date of request.

(2) Countable (see OAR 461-001-0000) income is
determined as follows:

(a) Income is considered available during a month under
OAR 461-140-0040.

(b) Income is not annualized, converted, or prorated.

(c) For a self-employed client, countable
self-employment income is determined under OAR 461-145-0920 and 461-145-0930.

(3) Except as provided in section (5) of this rule, the
Department calculates the countable income of the financial group (see OAR
461-110-0530) by adding together the income the financial group has already
received in the budget month and the income that reasonably may be expected to
be received in the budget month.

(4) A change in income or resources during a
certification period (see OAR 461-001-0000) does not affect the eligibility of
the benefit group (see OAR 461-110-0750) for that certification period.

(5) In the HKC, OHP-CHP, and OHP-OPC programs, when the
Department uses a finding made during an ELE determination and the child meets
all other HKC, OHP-CHP, or OHP-OPC program nonfinancial eligibility
requirements, the standard for the number of eligibility group members
determined by the ELA is used to determine eligibility regardless of the need
group (see OAR 461-110-0630) size. The countable income of the financial group
is the same as the income amount determined by the ELA.

(a) A child is deemed eligible for the HKC, OHP-CHP, or
OHP-OPC program as follows:

(A) If the income of the need group is below 163
percent of the federal poverty level (FPL) as listed in OAR 461-155-0180, the
Department deems the child eligible for OHP-OPC.

(B) If the income of the need group is at or above 163
percent of the FPL but under 201 percent of the FPL, the Department deems the
child eligible for OHP-CHP.

(C) If the income of the need group is at or above 201
percent of the FPL, the Department deems the child eligible for HKC.

(b) If the income of the need group is above 301
percent of the FPL, the Department determines eligibility using the standard
medical assistance eligibility determination processes.

(1) Deductions from income are subtracted from
countable income (see OAR 461-140-0010) in the following order to determine
adjusted income (see OAR 461-001-0000) for the SNAP program:

(a) An earned income deduction of 20 percent of
countable earned income. The 20 percent deduction is not taken from the wages
funded by grant diversions such as Work Supplementation wages.

(b) Effective October 1, 2010, a standard deduction of
$142 per month for a benefit group (see OAR 461-110-0750) of one, two, or three
individuals. A standard deduction of $153 for a benefit group of four
individuals. A standard deduction of $179 for a benefit group of five
individuals. A standard deduction of $205 for a benefit group of six or more
individuals.

(c) A dependent care deduction for dependent care costs
billed to a member of the financial group (see OAR 461-110-0530) and not paid
for through any other program of the Department. For the cost to be deductible
under this section, the care must be necessary to enable a member of the need
group (see OAR 461-110-0630) to:

(A) Accept or continue employment;

(B) Seek employment, including a job search that meets
the requirements of a case plan (see OAR 461-001-0020); or

(C) Attend vocational or educational training. A
student receiving educational income is entitled to a deduction only for costs
not excluded from educational income by OAR 461-145-0150.

(d) The medical deduction for elderly clients and
clients who have a disability (see OAR 461-001-0015) in the need group. The
deduction is calculated by determining the total of their deductible medical
costs (see OAR 461-160-0415) and subtracting $35. The remainder is the medical
deduction.

(e) A deduction for child support payments (including
cash medical support) a member of the household makes under a legal obligation
to a child not a member of the household group (see OAR 461-110-0210),
including payments for the current month and for payments on arrearages. Child
support is not deductible if collected by setoff through the Oregon Department
of Revenue or by interception of a federal tax refund.

(f) A shelter deduction, calculated as follows:

(A) For SNAP clients required to pay room and board in
a nonstandard living arrangement (see OAR 461-001-0000), the shelter deduction
is:

(i) The cost of room and board, minus the payment
standard for the benefit group; or

(ii) The actual room cost, if the client can prove that
the room cost exceeds the cost described in subparagraph (i) of this paragraph.

(B) For all other clients, the shelter deduction is
calculated as follows:

(i) The standard deduction and the deductions of earned
income, dependent care, court-ordered child support, and medical expenses are
subtracted from countable income. Fifty percent of the remainder is subtracted
from the shelter cost calculated in accordance with OAR 461-160-0420.

(ii) The rounded balance is the deduction, except the
deduction is limited if the filing group has no member who has a disability or
is elderly (see OAR 461-001-0015). Effective October 1, 2010 the limit is $458.

(2) If the client cannot verify a medical or
court-ordered child-support expense or cannot verify any other expense when
asked to do so, the unverified expense is not used to calculate the deduction.
If the client provides verification, the deduction is applied when calculating
the next month’s benefits. If verification is provided within the period
authorized for processing applications (see OAR 461-115-0210), the benefits for
the initial month (see OAR 461-001-0000) are recalculated using the deduction.

In the HKC and OHP programs, the Department uses income
to determine eligibility as follows:

(1) The countable (see OAR 461-001-0000) income of the
financial group (see OAR 461-110-0530) received and expected to be received in
the budget month (see OAR 461-001-0000) is determined under OAR 461-150-0055.

(2) For each member of the need group (see OAR
461-110-0630), the countable income of the financial group from the budget
month is compared to the applicable OHP program income standard. If the
countable income of the financial group is below the applicable income standard
for the need group size and all other financial and non-financial eligibility
requirements are met, the need group member is eligible for OHP program
benefits. If the countable income of the financial group equals or exceeds the
applicable OHP program income standard, the need group member is ineligible for
OHP program benefits.

Notes1.) This online version of the OREGON BULLETIN is provided for convenience of reference and enhanced access. The official, record copy of this publication is contained in the original Administrative Orders and Rulemaking Notices filed with the Secretary of State, Archives Division. Discrepancies, if any, are satisfied in favor of the original versions. Use the OAR Revision Cumulative Index found in the Oregon Bulletin to access a numerical list of rulemaking actions after November 15, 2010.